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MANUAL 


OF 

Artificial Limbs 


COPIOUSLY ILLUSTRATED 


Artificial Toes , Feet , Legs , Fingers , Hands , Arms, 
for Amputations and Deformities , Appliances 
for Excisions , Fractures , awe? Other Disa¬ 
bilities of Lower and Upper Extremi¬ 
ties , Suggestions on Amputations , 
Treatment of Stumps , ffis- 
tory , 


AN EXHAUSTIVE EXPOSITION OF PROTHESIS 


A. A. MARKS 

702 Broadway, New York, N. Y., U. S. A. 
1924 


Copyright by George E. Marks, 1924 

\\ 









KDnse, 

.tA324» 

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FEB 27 1924 


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<Vw 0 



PREFACE 


'anual of Artificial Limbs is the title given to this book to 
inguish it from the Treatise and all other publications which it 
ceeds and supplants. It is in no sense a catalogue, although con¬ 
ing the information usually given in catalogues; but it is a 
> manual of the subject of prothesis and the most exhaustive 
k ever produced on that topic. Prothesis or prosthesis is defined 
Webster as “The process of adding to the human body some 
ficial part in place of one that may be wanting.” 
lie Manual thus treats of all losses and impairments of the ex- 
lities, whether caused by accident, disease or birth, shows what 
r are and clearly describes how they may be repaired by artificial 
hods. 

he Manual is divided into chapters, each devoted to a distinct 
se of the subject or to a particular part of the leg or arm under 
aission. 

he illustrations are designated by letters and numbers for con- 
tence of reference. For example, partial foot amputations are 
Hissed in Chapter III, and the illustrations in that chapter all 
je the letter C and are numbered in order, 1, 2, 3, etc. Amputa- 
Is of different sections of the legs and arms are similarly divided 
the illustrations numbered in the same manner. This gives 
liteness and avoids confusions with earlier publications, 
le need of the Prothesist becomes more and more urgent every 
Losses of limbs by accidents and injuries of every kind are 
fctantly multiplying, and the demands made upon the thought- 
^nd skillful maker of artificial limbs and other surgical apparatus 
lease in the same proportion. 

ae successful maker cannot confine himself to the narrow 
hods of former times. Specific treatment is now called for in 
ost every case, the peculiarities of each requires closer study, 
irate methods must be devised by which complicated cases can 
reated more skillfully and reparation more complete. These 
advanced methods, called for by the progress of the science and 
fssitated by the importance of the work required. The skillful 
er thus occupies a much more prominent position than can be 
I by those who persist in clinging to archaic systems. It has 
l said by those most competent to judge that*the house of A. A. 
ks through persistent endeavor, broad enterprise, attentive study 
a real sense of the importance of the work has earned and occu- 
the foremost position in its branch of industry. 





4 


Preface 


While the loss of a limb is a serious personal deprivation, it is no 
longer regarded as a grievous or irreparable one. There are many 
thousands of people who walk, work and mingle with other people 
without disclosing their own loss and without suffering. The ab¬ 
sence of a leg or an arm, therefore, is now regarded, and quite 
rightly, as one of the minor misfortunes. Testimonials substantiat¬ 
ing these statements, and explaining and endorsing the principles 
presented in this Manual for the construction of artificial limbs, will 
be found in copious numbers in Chapter XXXVII. 



TABLE OF CONTENTS 

PAGE 

Preface.3 

Introduction ......... 15 


CHAPTEE I 

How We Walk. 

On natural feet.17 

On artificial feet with ankle-joints.19 

On spring mattress rubber feet without ankle-joints . 19 


CHAPTEE II 

Artifical Feet, Their Construction and Eelative 
Merits. 

The rubber foot.21 

The spring mattress.21 

Contrasts . . ..24 

The sponge rubber foot.24 

The pneumatic foot.24 

The wood foot . 24 

The ankle-joint rubber foot.25 

The felt foot . 25 

Ankle joints when ordered.26 

CHAPTEE III 
Partial Feet Amputations. 

Single-toe amputations.27 

Amputations at base of toes.27 

Instep amputations.28 

Ill-advised prothesis ..28 

Objections . . ..29 

Practical prothesis ..... . . 31 

Eetracted heels ..83 

Aluminum sockets ..35 

A 






















0 


Contents. 


CHAPTER IV 

PAGE 


Ankle-joint Amputations. 

Tibio-tarsal stumps 37 

End-bearing ......... 37 

Construction of suitable artificial leg . . . .39 

Partially end-bearing ....... 41 

Sensitive ends ........ 42 

Peg legs.44 


CHAPTER V 
Below-knee Amputations. 


Long tibial stumps .... 



. 45 

Enlarged non-end-bearing 



. 45 

No pressure at the popliteal space . 



. 46 

Tapering stumps ..... 



. 46 

Ordinary and short tibial stumps . 



. 50 

Artificial legs for tibial stumps 



. 50 

Construction ..... 



. 51 

Socket ....... 



. 51 

Knee-connection ..... 



. 51 

Steel joints ...... 



. 51 

Ballbearing joints ..... 



. 53 

Thigh part . . . . . 



. 53 

Lacing methods ..... 



. 53 

Check strap ...... 



. 54 

Sensitive stumps ..... 



. 55 

Non-end-bearing and end-bearing . 



. 55 

Thighless legs ..... 



. 56 

Dangers ...... 



. 57 

Slip sockets versus wood sockets 



. 58 

Slipping of the stump desirable 



. 59 

An instance ..... 



. 59 

Waterproof legs ..... 



. 60 

Bathing legs ..... 



. 60 

Shortened thigh ..... 



. 60 

Lateral adjusting socket 



. 62 

Contracted knee joints .... 



. 63 

Hypertrophied tibial stump . 



. 66 

Anchylosed knee tibial stumps extended 



. 66 

Peg legs. 



. 69 

Peg legs should not be used permamently 



. 70 

Ferrules for peg legs 



. 71 

Rubber tip . 

Suspenders ...... 



. 71 
. 71 



















Contents. 


7 


CHAPTER VI 


PAGE 

Knee-bearing Stumps. 

Definition. 73 

Knee-bearing legs . . . . . . .73 

Bolt joint ......... 75 

Side joint.76 

Peg legs ......... 77 

Incomplete restoratives . . . . . .77 

Suspenders . . . . . . . .78 


CHAPTER VII 


Disarticulated Knee Stumps. 

End-bearing and non-end-bearing stumps . . .79 

Fittings ......... 79 

Peculiarities of stumps . . . . . .80 

Most favorable conditions ...... 81 

Suitable artificial legs ....... 81 


CHAPTER VIII 
Thigh or Femoral Stumps. 


Definitions .... 





. 84 

Long or lower-third thigh stumps 





. 84 

Stumps out of line 





. 84 

Construction of legs 





. 85 

Variety of middle-third thigh stumps 




. 85 

End and non-end-bearing 





. 85 

Thorough control 





. 89 

Knee spring 





. 89 

Helps knee motion when walking 





. 90 

Spring strength can be regulated 





. 91 

Knee lock .... 





. 91 

Hip joints .... 





. 92 

Waterproof and bathing legs 





. 92 

Legs without knee-joints 





. 92 

Peg legs .... 





. 93 

Suspenders .... 





. 94 

Straight shoulder straps 





. 95 

Belt attachment 





. 96 

Vest method 






Suspenders for women . 





. 96 

Yoke method 






Corset method . • 

0 


© 

© 

. 97 





















8 


Contents. 


CHAPTER IX 

PAGE 


Hip-joint Amputations. 
Requirement 
Muscle stump 
Leg applied 


98 

98 

100 


CHAPTER X 


Both Leg Amputations. 


Ancient methods ..... 



. 101 

Both feet partly amputated . 



. 102 

Lower instep and leg amputation . 



. 103 

Both feet amputated at the ankles 



. 103 

Ankle-joint and knee amputations 



. 103 

Upper instep and leg amputations 



. 104 

Both leg amputations 



. 106 

Practical results ..... 



. 106 

Below-knee and knee-joint amputations 



. Ill 

Below-knee and above-knee amputations 



. Ill 

Engaging in former pursuits . 



. 112 

Both legs and both arms amputated 



. 113 

Both legs amputated above the knees 



. 113 


CHAPTER XI 


Artificial Feet and Legs for Deformities, Paralysis, Ex¬ 
cisions, Arrested Growth, Shortened Growth, etc. 
Short leg ......... 

Talipes-equinus ........ 

Talipes with lateral weakness . 

Toe support ........ 

Congenital deformity ....... 

Talipes-varus ........ 

Leg deformities ........ 

Infantile paralysis ....... 

Obstructed growth ....... 

Both legs deformed ....... 

Drop foot ......... 

Knee joints locked ....... 

Limited knee motions ....... 

Ununited fractures ....... 

Fractured knee caps, etc. ...... 


119 

119 

120 
120 
122 
123 
123 
126 
127 
129 

134 

135 
135 

137 

138 


CHAPTER XII 


Facts for Consideration. 

Wooden feet substituted by rubber ones . . . 139 

A way to test the rubber foot . , „ 139 













Contents . 


9 


PAGE 


Fitting—an art .... 




. 139 

Only one way to fit 




. 140 

When plaster casts are useless 




. 140 

Machine fitting a failure 




. 140 

When casts are necessary 




. 141 

Wood sockets the best . 




. 141 

Weight. 





Rubber foot not heavy . 




. 141 

Odor ...... 




. 143 

Temperature .... 





The mass of limb wearers are of small means 



. 143 

How long will a leg last? 




. 144 

Shoes and stockings 




. 144 

How soon after amputation should an artificial leg be 

applied ? .... 




. 144 

Treatment of stump 




. 144 

The gain of applying a leg immediately 




. 146 

Hangers in delay 




. 146 

Cork legs ..... 




. 146 

CHAPTER XIH 

Artificial Legs for the Aged 

• 

• 

• 

. 148 

CHAPTER XIV 

Artificial Legs for Infants and Children. 

The problem considered 




. 151 

Support from the pelvis more natural 




. 152 

Alterations for growth . 




. 152 

Frequency of alterations 




. 152 

The parents’ moral obligation 




. 153 

Deformities from the use of crutches 




. 153 

Practical illustrations . 




. 154 

CHAPTER XV 

Home Measurements. 

Instructions when one leg is amputated 



. 165 

Diagrams ..... 




. 165 

Measurements .... 

. 



. 167 

Instructions when both legs are amputated 



. 170 

Plaster casts .... 

. 



. 172 

Accessories . . . . « 

. 



. 175 

Terms of payment 

. 



. 175 

Guarantee ..... 




. 175 

CHAPTER XVI 

When extreme conservatism in amputations 

became 

a 

menace ..... 

. 

. 

. 

. 176 

Code. 

. 

. 

. 

. 194 


















10 


Contents. 


CHAPTER XVII 

PAGE 

Hands and Arms, Natural Compared with Artificial. 

History ......... 201 

The demand greater ....... 201 

Simplicity ......... 202 

What an artificial arm must do .... 202 

The natural hand a maryel ...... 202 

The brain.202 

Self-repairing ........ 203 

Sense of touch ........ 203 

Stories misleading ........ 203 

CHAPTER XVIII 

Is it Profitable to Buy an Artificial Arm? 

Ornamentation ........ 205 

Hygiene.206 

CHAPTER XIX 

Wooden Hands. Rubber Hands. 

Old methods.210 

New methods ........ 210 

Ductile fingers. 210 

Palm locks ......... 211 

Wrist connections ........ 211 

Clamps.211 

Flexion ......... 212 

Spring thumb.213 

Gloves always to be worn.214 

Choice of material for sockets ...... 214 

CHAPTER XX 
Partial Hand Amputations. 

The loss of one finger ....... 216 

Materials ........ 217 

The loss of two or more fingers . . . . . 218 

Individual fingers ........ 219 

Construction ......... 219 

CHAPTER XXI 
Wrist-joint Amputations. 

Flat ends ........ 222 

Tapering ends ...... 223 






















Contents. 


11 


CHAPTER XXII 

PAGE 

Forearm Amputations. 

Leather elbow joints ....... 224 

Steel elbow joints ........ 227 

Short stumps ........ 228 

Arms without hands ....... 228 

Suspenders ......... 228 

CHAPTER XXIII 

Elbow-joint Amputations. 

Short radial stumps ....... 231 

Construction ......... 231 

Arms without hands ....... 232 

CHAPTER XXIV 

Above Elbow Amputations. 

Elbow lock ......... 234 

CHAPTER XXY 

Shoulder-joint Amputations.235 

CHAPTER XXYI 

Double Arm Amputations .238 

CHAPTER XXYII 

Appliances for Deformities, Excisions, Weakened Joints, 

Etc.242 

CHAPTER XXYIII 

Arm Implements.246 

CHAPTER XXIX 

Utility.248 

CHAPTER XXX 

Directions for Taking Measurements for One or a Pair 

of Artificial Arms ....... 252 

Arms fitted from measurements ..... 255 

Accessories ......... 256 














12 


Contents . 


CHAPTER XXXI 

PAGE 

Terms of Payment, Installment Payments, Guarantee. 

Advanced payment avoids delay ..... 257 

How to make payments ....... 257 

Our reliability ........ 257 

Success most important to us . . . . . . 257 

Advanced payments are in the interest of the wearers . 257 
Artificial limbs on trial, prejudicial to success . . . 258 

Why correctly made limbs are not always pleasant at the 

start.. 258 

Patient endeavor brings its reward ..... 258 

Money deposited in banks not acceptable .... 259 

Installment payments ....... 259 

Deferred payments must be guaranteed .... 259 

Acceptable guarantors ^ ..... . 259 

Our guarantee ........ 260 


CHAPTER XXXII 

Pensioners of the United States Army and Navy Furnished 


with Artificial Limbs at Government Expense 


The original law ..... 



. 261 

The amended law ..... 



. 261 

The new law now in force 



. 261 

Transportation free .... 



. 261 

The bond ...... 



. 261 

Advantages in registering with us . 



. 262 

Those amputated in the World War 



. 262 


CHAPTER XXXIII 
Cheap Artificial Limbs. 


Cheaply made limbs not safe . 




. 263 

Inviting disaster .... 

. 

. 


. 263 

Confidence necessary to success 

. 

. 


. 264 

Selection of material 

. 

. 

# 

. 264 


CHAPTER XXXIV 


Do the Maimed Die Young? 

A false belief.266 

What our records disclose.266 

Amputations revitalize the system ..... 266 

Illustrations ........ 267 

Athletes ........ 267 

Compensation ........ 267 

Gratitude .... oaq 














Contents. 


13 


CHAPTER XXXV 


Awards 

CHAPTER XXXVI 

* 

PAGE 

. 269 

Testimonials 

• • • • 


. 277 


CHAPTER XXXVII 


Contentions. 


1st 

Contention 








. 278 

2nd 

tt 








. 278 

3rd 

tt 








. 280 

4th 

tt 








. 281 

5th 

tt 








. 288 

6th 

It 








. 288 

7th 

tt 








. 288 

8th 

it 








. 289 

9th 

it 








. 289 

10th 

tt 








. 289 

11th 

it 








. 289 

12th 

a 








. 289 

13th 

tt 








. 289 

14th 

tt 








. 290 

15th 

it 








. 290 

16th 

it 








. 290 

17th 

tt 








. 290 

18th 

tt 








. 291 

19th 

tt 








. 291 

20th 

tt 








. 291 

21st 

tt 








. 291 

22nd 

a 








. 292 

23rd 

tt 








. 293 


CHAPTER XXXVIII 

George Hy. Barstow, British Representative . . . 294 


CHAPTER XXXIX 


Stump Socks and Accessories .296 

CHAPTER XL 

How to Reach Our Establishment. 

,Where we are located ....... 299 

We meet patrons ........ 299 










14 


Contents. 


Business hours ........ 299 

Board and lodging ....... 299 

Where to have your mail addressed .... 300 

Calls made to residences ...... 300 

Women in attendance ....... 300 

Branches . . . . . . . . . 300 

Price List . .301 









INTRODUCTION 


In reviewing “Manual of Artificial Limbs” and introducing same 
to the reader privilege is taken to advert briefly to the House itself 
and its enviable history. 

The house of A. A. Marks was founded for the sole purpose of 
relieving and helping the maimed and deformed. Established in 
the year 1853 it has had an unbroken existence of over seventy 
years and is to-day as it has been for many years the leading house 
of its kind in the world. 

Its manufacturing plants, the factory and office in New York City, 
the mill and storehouses out of town, occupy more ground and keep 
more men employed than all the artificial limb manufacturers in the 
United States combined with the exception of but a few. The 
business is a large one, conducted in a large way and by men thor¬ 
oughly trained with every detail of artificial limb construction. 

Their specialty is the making of artificial legs and arms with 
rubber feet and hands, of which they are the inventors and 
patentees. The spring mattress rubber foot and the rubber hand 
with ductile fingers are valuable improvements. That the house has 
grown from a small shop to a vast manufacturing establishment 
with a hundred thousand correspondents located in all parts of the 
world is due not only to the intelligent way in which its business 
has been conducted, but to the inherent merits of its products. These 
are described at length in the pages that follow. 

Modern skill has brought no more useful aid to humanity than 
the artificial limb which transforms a helpless dependent into a useful 
member of society. 

The firm does not claim that every maimed and crippled person 
can be restored to the full functioning of the lost parts. It does, 
however, claim that its skill and facilities help the maimed to a 
gratifying degree. 

This book has been prepared not only as an exposition of the 
firm’s business but as a guide for the mind of the reader in seeking 
amelioration. 

The firm manufactures limbs for simple amputations as well as 
for the most complicated and difficult ones. It has developed 
special types of limbs for groups of special cases, many of which are 

15 





16 


Introduction 


of utmost complexity; it has fitted and helped persons with delicate 
and tender stumps, also many with stumps of awkward shape and 
difficult forms; it has applied artificial limbs and appliances to per¬ 
sons with one sound limb as well as to those who have been 
deprived of both, and the volume of testimony it has on view 
received from its clients, filled with gratitude, stimulates it to con¬ 
tinued endeavors. 

The book is destined to be an authority on the important subject of 
prothesis, a book of interest and concern to the surgeon and phy¬ 
sician as well as to the maimed. It contains not only a description 
of multifarious devices but much general matter both descriptive 
and critical, and in a way didactic, bearing close relations to the 
work of the surgeon. 

It is a matter of highest gratification and pride that in all the 
exhibitions in which the firm of A. A. Marks has been represented 
it has received forty-six first and highest awards, always in compe¬ 
tition with others. But the freely proffered expressions of regard 
and satisfaction from its clients, from the men and women who 
have been helped and whose lives have been aided and bettered 
through the use of its apparatus, are more stimulating, and the very 
highest measure of praise one can hope to receive. Numerous as 
are those that are printed, they constitute but a fragment of the 
kind and grateful words that have been uttered in its favor during 
its career. 

The book will reach many readers. To them let us say one word. 
The firm of A. A. Marks has helped others. It surely can help 
you. 


James Law, M. D. 



CHAPTER I 


HOW WE WALK 

On Natural Feet. —No two persons walk exactly alike. Every¬ 
one carries his mannerisms in his steps. The way in which he lands 
on his heel, rolls on the .sole, lifts on the ball, throws himself to the 
right or the left, the uniformity and regularity of each joint’s 
action, the angle at which the hip is checked, the range of articula¬ 
tion permitted in the knee and the angular motion of the ankle,— 
all form a part of his individuality and make it possible to dis¬ 
tinguish a friend from a stranger long before his features have 
come within the reach of vision. All sorts of forces—heredity, 
early habits, occupation, disease, injuries, and age—influence the 
movements of the leg and foot. A man in good health walks dif¬ 
ferently from an invalid, a farmer can be distinguished from a 
merchant, a bookkeeper from a railroad conductor, the sprightli¬ 
ness of youth, the infirmities of age are reflected in every step that 
is taken. Yet there are certain facts connected with walking that 
are common to all and which can be ascertained by observation and 
study. These facts are so universal that they become laws govern¬ 
ing locomotion; they form a necessary part of the limb-maker’s 
education, and unless he is familiar with them and applies them 
thoughtfully to the construction of artificial limbs, he is not com¬ 
petent to work out the problems that are continually arising. 

As this work is designed as a text-book on artificial limbs, it is 
essential, at the outset, to present the cardinal facts relating to 
natural walking, in order that the application of them to artificial 
aids may be clearly understood and appreciated. 

Kinetoscopic photography affords the most valuable aid to an 
investigation of the actions of the knee and ankle joints when 
performing their functions. It shows that when a man walks 
slowly, say two miles an hour, the knee flexes but slightly and the 
ankle considerably. When walking three miles an hour, the knee 
joint acts through a greater range and the ankle joint through a 
lesser one. When walking moderately fast, say four miles an 
hour, the knee action becomes considerable and the ankle action 
scarcely perceptible. When walking rapidly, say five miles an 
hour, the knee action is increased and the ankle becomes prac¬ 
tically rigid. When running the knee increases its activity, and 
the ankle reverses its action and throws the man forward by 
the ball of the foot. 

The ratio that exists between the range of motion of the knee 
and that of the ankle is in proportion to the speed with which one 
moves. An impulse is had to walk slowly or rapidly, or to change 


18 


A. A. Maries, Artificial Limbs, New York City . 


from one gait to another. The proper muscles and tendons 
instantly respond to the mind, and the required speed is attained. 
If the co-operation between the mind and muscles be disrupted 
the person becomes a paralytic and his steps are unreliable. The 
same may be said of a person walking on an artificial leg with 
ankle motion that is not under control. 

Three miles an hour is the ordinary gait of a person occupied in 




Cut A 3. 



Cut A 4. 


commercial life. Successive photographs of a man with natural 
legs, walking at this gait, show that there is but very little motion 
in the ankle joint; and limited as that motion is, it is of a charac¬ 
ter that cannot be imitated by mechanical means. The walker 
throws his left foot forward, barely touching the heel to the 




Cut A 7. 


Cut A 8. 


ground, as shown m Cut A 1; instantly the right foot under con¬ 
trol of the tendo-Achilles extends and the heel is raised from the 
ground, throwing the weight of the body on the ball, supplying the 
impetus that urges the body forward. As the body is carried 








A. A. Marks , Artificial Limbs, New York City. 


19 


forward, the ball of the left foot reaches the ground at about the 
time the body is vertically over it, as shown in Cut A 2. At this 
point the right foot is in the act of leaving the ground, and, as 
shown in Cut A 3, is passing the left which, still being flat on 
the ground, performs no function, except that of supporting the 
body, as shown in Cut A 4. The right leg is carried a little 
further forward when a slight amount of flexion is admitted in 
the left ankle joint, as shown in Cut A 5. But this is for a very 
brief period, as Cut A 6 shows that the tendo-Achilles instantly 
contracts and the foot extends and the entire body is lifted and 
thrown on the ball, and when the weight of the body is placed on 
the heel of the right foot, there is a slight flexion in the knee joint 
which permits the sole to reach the ground. At this time, the 
knee joint of the left is flexed and the foot of that leg is raised, 
as shown in Cut A 7, and when the weight of the body is prac¬ 
tically over the right foot the knee is extended, so as to support 
the weight securely, as shown in Cut A 8. 

A study of these successive photographs shows that in making a 
complete step the soles of both feet are not on the ground at the 
same time, and at times when the weight of the body is placed 
equally on each foot, the heel of the advanced foot and the toes 
of the rear foot are only those parts that are on the ground. It 
also shows that propulsion is obtained by rising on the ball of the 
rear foot. 

On Artificial Feet with Ankle Joints. —Similar photographs 
of a man walking with one or a pair of artificial legs with ankle 
joints set to act at a constant range of motion, show that he walks 
fairly well at a slow gait, but at a speed of three or more miles 
an hour his step becomes perceptibly awkward, and the effort re¬ 
quired to overcome the too liberal motion in the ankle is fati¬ 
guing. So far as the knee joint is concerned the motions of the 
artificial and natural legs are approximately the same, but the 
motions of the ankles are very different. The sole of the foot is 
flat on the ground for a considerably longer period with the arti¬ 
ficial ankle joint than with the natural. As the walker advances 
and strikes the heel of the artificial foot on the ground, almost 
immediately the front of the foot drops and the entire sole rests 
on the ground and remains there during the interval through which 
the body is passing over it. 

Having made plain the movements of the natural foot in walk¬ 
ing, and contrasted them with the movements of the artificial foot 
articulating at the ankle, we now propose to carry the contrast to 
the spring-mattress rubber foot attached rigidly to the leg socket. 

On Spring-Mattress Kubber Feet without Ankle Joints.— As 
the walker advances on the rubber foot he touches the heel to 
the ground. He applies his weight, and the sponge rubber in the 
heel compresses sufficiently to allow him to roll on the bottom of 
the foot; the moment the body is carried a little in advance, he 
rises on the ball very much the same as he does on the natural 
foot. There is no effort required to lift on the ball, as the weight 



20 


A. A. Maries , Artificial Limbs, New York City. 


of the body, being in advance of its center of gravity, overcomes 
that apparent obstruction; not a muscle or tendon is brought into 
play; the weight of the body does the entire work. 

These studies and comparisons of the movements in walking 
bring out very clearly the essential fact that with the artificial 
ankle joint the interval that the plantar surface rests on the 
ground is very much greater than that of the natural foot, while 
with the sponge rubber spring-mattress foot it is approximately 
the same, and, by compelling the walker to rise on the ball, pro¬ 
duces a very natural action, giving greater assistance in walking 
and dispensing with a vast amount of mechanism. 

It is apparent also that the value of mental force in controlling 
the actions of the natural ankle joint cannot be overestimated. 
When these forces become inert, as they necessarily do in artificial 
joints, the embarrassments that follow are the same as with 
paralytics, locomotor ataxia, etc. The injured are obliged to walk 
cautiously, the affected foot is placed almost entirely by the sense 
of sight, and the step is made with meditation and progress must 
necessarily be slow. 

If an artificial leg with ankle articulation be applied to a person 
who desires to walk at a gait faster than two miles an hour, he 
will find himself not only greatly hindered, but required to put 
more energy into the natural foot and leg in order to overcome the 
influence of the articulating ankle in retarding his progress. The 
rubber foot without ankle joint will assist rather than hinder rapid 
walking, and will not hinder slow walking when desired. 



CHAPTER II 


ARTIFICIAL FEET, THEIR CONSTRUCTION AND 
RELATIVE MERITS 

The Corded Rubber Foot. —With an experience of eight years 
in manufacturing artificial legs with wood feet, articulating at the 
toes and ankles, A. A. Marks in 1861 invented the sponge rubber 
foot, to protect which the United States Government issued letters 
patent in 1863. Like all great inventions it passed through various 
stages of development. 




In July, 1921, we entered into experiments for the purpose of 
adapting the principle of the corded tire used on automobiles to the 
rubber foot, thereby imparting to it those excellent qualities that 
have made the corded tire more elastic and far more durable. The 
results of our experiments have been most gratifying. 

For better understanding, we will take a Corded Rubber Foot 
with Spring Mattress and split it lengthwise, the interior with all its 
parts will be exposed to view. 

Fig. 1 shows the foot with weight equally applied to heel and ball. 

Fig. 2 shows a corded re-enforcement, made of strong Sea Island 

21 



















22 A. A. Marks, Artificial Limbs, New York City . 


Cotton Cord imbedded in pure gum rubber. This is placed under 
the end of the core, marked B. This re-enforcement receives all the 
weight of the wearer when applied to the front of the foot, distribut¬ 
ing it over a very large surface, thereby preventing the core from 
working its way into the rubber and displacing the toes. 

Fig. 3 represents the corded inner sole which is made of hard 
twisted Sea Island Cotton Cord laid in two rows, one crossing the 
other and both obliquely to the line of the foot, the spaces between 
the cords are square and filled with elastic pure gum rubber 
thoroughly adhered to the cords; when walking the weight of the 
wearer is first on the heel, then on the ball; in either case the square 
spaces are pulled lengthwise and become diamond shaped, producing 
a pulling force which as soon as weight is relieved pulls the toes back 
to their proper positions. This corded inner sole is located in the 
foot very close to the outer sole, as shown in Fig. 4 by letter E. 



Fig. 4 shows the Corded Rubber Foot with Spring Mattress weight 
applied to the ball. 

A, the base of the leg or core of the foot. 

B, the corded re-enforcement as represented by Fig. 2. 

C, represents sponge rubber of large porosity. 

D, the spring mattress located immediately above the corded 

inner sole. 

E, the corded inner sole in its proper position. 

F, the sheet of Pure Gum Rubber which completely surrounds 

the foot. 

With the exception of the corded re-enforcement B, under the for¬ 
ward part of the core, and the corded inner sole E, placed under the 
tread, the rubber foot is the same as it has been for years. 

The number of clients now walking on the corded rubber foot with 
spring mattress are many. The easy tread and quick response of the 
toes at every step together with the assurance of durability are 
accomplished results long sought after. Patent granted June 20, 
1922. 

Cut B represents the foot on an inclined surface. On account 
of the yielding quality of the rubber, the up-hill side of the foot 






A. A. Marks, Artificial Limbs, New York City. 


23 


will compress and accommodate itself to the incline and allow the 
foot to remain on its base. This is accomplished without com¬ 
plicated mechanical lateral articulation. 

The spring mattress not only forces the parts of the foot back to 
their proper shape, but obviates the exertion required to operate 
the antiquated articulated wooden foot. 

The impression that one receives on the new spring-mattress foot 
is both pleasant and agreeable. This is especially the case to one 
who has worn an artificial leg with wooden articulating foot. 

It can readily be seen that any motion in the ankle that cannot 
be controlled by the will must be mechanical in appearance as well 
as in action. The approach to nature is made more positive by 
their omission. 

It is the experienced man, the man who has experimented with 
tnany kinds of artificial limbs, who is capable of appreciating the 



Cut B 4. 

principles involved in the rubber foot. He comprehends the reason 
why the wearers of artificial limbs with rubber feet walk further, 
faster, and with less fatigue, than those walking on ankle-jointed 
wooden feet. 

The contrast between the two kinds is most striking in run¬ 
ning. With the rubber as with the natural foot the entire plantar 
surface is never on the ground. It is the heel-and-toe touch to the 
ground that distinguishes the walker from the runner. This is 
extremely difficult with the ankle-jointed foot. When standing the 
immovably attached rubber foot furnishes a large base on which to 
balance; hence, a man with two artificial legs with immovably 
attached feet can stand restfully and safely without assuming 
awkward and unnatural positions, for he is not required to main¬ 
tain his equilibrium on a point. 

The rubber foot with spring mattress provides the laborer a 
substantial substitute with which to support and brace himself 
when working at the bench, on the road, on the farm, or at what* 





24 A. A. Marks, Artificial Limbs, New York City. 


ever occupation he may be engaged. There are no uncertain or 
treacherous movements to hamper him or make his position un¬ 
certain. 

A painter who wears a Marks rubber foot says he can climb a 
ladder, stand on a scaffold, balance himself at any elevation with 
absolute safety. With an ankle-joint leg he would feel tottlish, 
and, when on his ladder, would have to depend more on the grasp 
of his hands than on his foot; but, with the rubber foot, his base 
is substantial and reliable. 

A farmer who toils in the field can plod along over stony or 
muddy ground on a rubber foot with safety. The accumulation of 
mud on his shoes does not cause his toe to drop and trip him. 
Uneven surfaces will not throw him from his balance or violently 
jar his stump. We have thousands of testimonials on these points. 

Contrasts. —There are two kinds of rubber feet. One is known 
as the sponge rubber foot; and the other as the pneumatic rubber 
foot. We will endeavor to make clear the difference between them. 

When rubber is cured so that it possesses a great number of 
small air cells, the same as a sponge, it is called sponge rubber, and 
a foot made in this way is known as a sponge rubber foot. 

A foot made of a sheet of rubber cast into the shape of a foot, 
possessing one or a limited number of large chambers into which 
air is pumped until sufficient pressure is obtained to maintain 
shape and possess resiliency is called a pneumatic foot. 

The Sponge Rubber Foot. —Is composed of a vast number of 
cells, each charged with air created by the volatilization of a 
chemical while the rubber is being vulcanized. Each cell is sur¬ 
rounded by a wall of rubber possessing a sustaining power suf¬ 
ficient to maintain itself should it become deflated. In fact, if all 
the cells become deflated the foot would keep its shape on account 
of the presence of the sustaining walls, therefore the shape and 
resilience of the sponge rubber foot are not dependent upon the 
air in the cells. 

The Pneumatic Foot. —Having but a limited number of large 
air chambers into which compressed air is forced, is wholly de¬ 
pendent upon the presence and retention of the compressed air 
for its stability. The sponge rubber spring-mattress foot receives 
no injury from puncture. The pneumatic foot will collapse and 
lose its sustaining power the moment the air chamber is pen¬ 
etrated. A protruding nail or peg in a shoe will puncture a pneu¬ 
matic foot and put it out of service until the puncture is patched 
and the foot pumped up again with air. 

The sponge rubber foot never has to be recharged with air. 

The Wood Foot. —Is now somewhat antiquated. Like the hard 
tire of the carriage wheel of yesterday it no longer holds the 
position of importance it had for many years—rubber is rapidly 
supplanting it. The wooden foot articulating at the ankle and 
the toes is a mechanical contrivance, very complicated and there¬ 
fore very easily disarranged. The methods of construction are as 
varied as the makers who manufacture them. Nearly every maker 



A. A. Maries, Artificial Limbs, New York City. 25 


has a type of his own, yet all are essentially the same. Some admit 
of a large range of ankle articulation, while others limit it so that 
there is but very slight motion. Some have side motion; others, 
equally as conscientious, condemn that motion and employ only 
front and back motion. Being convinced by most careful study and 
experimentation that an artificial leg is improved in proportion to 
the abridgment of its mechanical movements, we dissuade all from 
using the side motion. Some manufacturers employ rubber for 
springs in the ankle and toes; others prefer steel. One method has 
little advantage over the other. 

The Ankle-Joint Kubber Foot. —Cut B 5 represents an ankle* 
jointed rubber foot after our preferred plan. Cut B 6 represents 



Cut B 6. 


Cut B 5. 


the ankle articulation in sectional view. The axis on which the 
foot moves consists of a bolt that passes through the foot at the 
ankle, connected with steel strips riveted to the lower sides of the 
leg. A steel spiral compression spring, one end of which is placed 
in a cylinder and the other, receiving a piston, is placed in the 
ankle in such manner as to act on the rear part of the foot, im¬ 
pinging against the front interior part of the socket, forcing the 
heel downward and the front of the foot upward. The articulation 
at the ankle is limited by the check cord placed in the rear. It is 
made of the strongest flexible material. This method of articula¬ 
tion can be used with wooden feet as well as rubber ones. When 
rubber is used it is not necessary to have a mechanical articulation 
at the base of the toes as the rubber itself will furnish that motion. 
Cut B 7 represents the ankle at extension, the foot flat on the 
ground when the leg is thrown forward and weight applied. Cut 
B 8 represents the ankle at flexion and weight applied to the toes. 

The Felt Foot.—Is so seldom used that it is only referred to here 
in order to make our descriptions complete. Its use is to be 
strongly condemned. Fglt possesses no stability. It is an absorb¬ 
ent of moisture and lacks resiliency, and is therefore wanting in 
the most essential qualities that should characterize the material 
used in the construction of an artificial foot. 








26 


A. A . Marks, Artificial Limbs, New York City, 


Ankle Joints when Preferred. —While many years of observa¬ 
tion and study have convinced us that the best results are obtained 
from artificial legs with rubber feet rigidly attached, it is neverthe¬ 
less true that some persons form prejudices that cannot be removed 
even by the most logical arguments. Another class, who may be 
put in the same group, are those who, for a long period, have worn 
artificial limbs with articulating ankles; and have become so inured 
to them that a change, no matter how beneficial it might ultimately 
prove, would subject them to annoyance. We care not to antago¬ 
nize those who think and feel this way; we are therefore prepared 



Cut B 7. Cut B 8. 


to construct artificial legs for them that are similar in construction 
to those they have worn and have become accustomed to. 

We frequently hear of persons who are inclined to patronize us 
on account of the reputability of the house, but who hesitate in 
doing so on account of their doubts as to whether they themselves 
would make a success with artificial legs without ankle articula¬ 
tions. The idea of the rubber foot is acceptable, but rigidity at the 
ankle is doubtful. The element of doubt hinders their entering 
into any experiment the success of which is entirely at their risk. 

We are disposed to meet any such person on a basis of equity and 
will funish him with an artificial leg with rubber foot rigidly 
attached at the ankle with the understanding that, if after reason¬ 
able trial he feels that he would prefer the ankle joint, we will 
apply one for him without extra charge. 

As we regard rubber feet rigidly attached at the ankle better for 
general purposes, we make limbs that way unless otherwise in¬ 
structed. 

Prices are the same whether rubber feet are permanently attached 
or made to articulate, whether feet are of wood, metal, or rubber. 



CHAPTER III 

PARTIAL FEET AMPUTATIONS 


Single-Toe Amputations. —The loss of a single toe, particularly 
if it be the great one, may or may not be the cause of inconvenience 
and discomfort, yet the application of an artificial part is often 
found necessary, both as an aid in walking and as a protection to 
the amputated surface. 

If one or more of the interplaced toes are removed and the 
hiatus has been filled up by the union of the adjacent surfaces, 
there can be no gain whatever in applying artificial ones. If the 
great toe (see Cut C 1) or the small toe be removed, and the am- 



Cut C 1. Cut C 2. Cut C 3. 


putated surface is tender and painful to the touch, an appliance 
similar to that represented in Cut C 2 can be advantageously 
applied. 

This appliance consists of a duplicate of the removed part, made 
of suitable material and secured to a plate shaped as the sole of 
the foot. It is held to the foot by an incasement of leather, laced 
down the front; when applied it is ready for the shoe, as shown in 
Cut C 3. This simple arrangement protects the amputated sur¬ 
face, assists in walking, fills the shoe, and prevents unsightly 
wrinkles in the leather. 

Amputations at Base of Toes. —It is necessary to apply an arti¬ 
ficial part when all the toes have been removed, as shown in Cut 
C 4. It must be so constructed that it can be held in place and 
avoid pressure on the scarred surface. Shoes stuffed with cotton 
or with pieces of cork should never be used; such expedients, having 
no support on the under sides, will eventually encroach on the 
amputated surfaces and permit the shoe to bend near the ends of 
the stumps. 

An appliance illustrated in Cut C 5 is suitable for such an 
amputation; it is shown applied in Cut C 6. It can be made of 
wood or metal as may be required, and shaped to receive the foot in 
a comfortable manner; tender points are protected by recesses pro- 

27 




28 


A. A. Marks, Artificial Limbs, New York City, 


vided for them. Cut C 6 shows this apparatus applied and ready 
for the shoe. Usually the mate to the shoe worn on the natural 
foot can be used without alteration; in cases where more room is 



A. A. MARKS, N.Y, 


Cut C 4. 




Cut C 5. 


Cut C 6. 


needed, almost any shoemaker can supply it by ripping off part of 
the upper and substituting a larger piece. 

Instep Amputations. —These are termed tarso-metatarsal and 
medio-tarsal by the surgical profession, and are frequently des¬ 
ignated by the names of the surgeons who first performed them, 
as Chopart, Lisfranc, Hays, Hancock, and many others. These 
amputations are performed with the object of sacrificing as little 
of the foot as possible, and retaining the heel and a part of the foot 
as a base on which the patient is supposed to be able to walk or 
stand. Although a person with the front part of his foot removed 
may be able to get about with an ordinary shoe, it is not long before 
he discovers that something is lacking and his locomotion impeded 
by the absence of the removed part. He may pack the vacancy in 
his shoe with cotton, cork, or other material, and may re-enforce the 
sole with a steel plate; but he soon finds that only partial relief 
has been obtained, and that there is an imperative demand for a 
substitute for the ball of the foot which will enable him to rise on 
and elevate his heel from the ground. Something is needed having 
great strength and that can be firmly secured to the remaining 
part of foot and leg. 

The construction of artificial feet for this class of amputations 
has taxed the ingenuity of artificial-limb-makers for many years. 
The absence of space between the bottom of the heel and the floor 
presented an obstacle to the construction of a helpful and durable 
appliance until aluminum was employed. It may be useful to re¬ 
view some of the devices used for such cases. 

Cut C 7 represents a stump resulting from a partial foot amputa¬ 
tion. 

Ill-Advised Prothesis. —Cut C 8 represents the way in which 
many manufacturers have endeavored to supply the want. The 
appliance consists of a leather shoe inclosing the stump and part of 
the ankle, the front of which is made of wood, rubber, or cork with 
a metal plate at the base, running from heel to toe, calculated to 
make the sole firm and unyielding at the ball. This apparatus 
gives a natural appearance to the amputated member, but fails to 
support the wearer in a helpful or substantial way. The stump 
will soon crowd forward, coming into unpleasant contact with the 



A. A. Marks, Artificial Limbs, New York City. 


29 


appliance; the steel plate will bend or break and the shoe will 
yield where the stump terminates, creasing* the shoe and making 
it rocker-shaped; consequently it utterly fails in supplying the 
want, because of the lack of firmness with which it is held to the 
remaining part; the heel, moreover, will yield to the constantly 
contracting tendency of the tendo-Achilles and become displaced. 

Cut C 9 represents another ill-advised apparatus. It consists of 
a sheet of metal formed to receive the remaining plantar surface 




Cal <J u. 


of the foot; bent up on either side, hinged at the ankle to steel 
straps thus providing a joint for ankle articulation; the steel straps 
run up the sides of the leg and are held in position by a leather 
corset, shaped to inclose the leg. The front of the metal sole is 
secured to a part of a foot. The main objection to this device is 
the insecurity of the attachment; weight applied to the ball of the 
foot will cause the ankle to flex and permit the amputated surface 
of the stump to rub against either the front or the bottom plate, 
causing abrasions; a heel cord placed at the back connecting the 
leg section with the foot plate will not be effective in holding the 
appliance in its proper position at all times and checking the 
action of the ankle articulation at the proper angle. 

Objections. — A glance will show that the legs illustrated in Cuts 
C 8 and C 9 must prove inadequate. When weight is applied to 
the ball of the foot the heel of the artificial part will remain on the 
ground, while the heel of the stump will lift away. The wearer 
will walk flat-footed and will press the delicate cicatrized surface 
against the attachment. These conditions will not only cause 
suffering but defeat the object of the artificial foot. 

It might appear that an appliance constructed on the plan shown 
in Cut^ C 5 could be secured so firmly to the remaining part of a 
Chopart stump as to enable the wearer to rise on the ball. If this 
were possible the method of treatment would be greatly simplified; 
unfortunately, however, the severity of the compression needful 






30 


A. A. Marks, Artificial Limbs, New York City. 


to hold the appliance in place when weight is thrown on the ball, 
will stop the flow of blood in the heel, causing great pain, endanger¬ 
ing the health of the entire leg. 



It is important to emphasize the fact that it is absolutely useless 
to apply any form of foot to a partial foot stump unless the artifi¬ 
cial part is held so firmly that the wearer may rise on the ball of the 



foot, and not only support his weight while in that position but 
carry such additional weight and resist such strains as his habits 
or occupation demand. 

Cut C 10 represents an amputation a little forward of the instep. 



















A. A. Marks , Artificial Limbs, New York City. 31 


The wisdom of the application of apparatus C 5 in this case is 
doubtful. It might prove adequate in the case of a person who 
does little walking and no lifting, and who places little demand on 
the front part of the foot; but for a laboring man, who has to lift 
and carry articles of weight, it would be a disappointment. It will 
be better considered, therefore, among instep amputations that re¬ 
quire the placing and distribution of the strain above the ankle 
joint. 

Cuts C 11, C 12, C 13, and C 14 show instep amputations after 
the Lisfranc, Hancock, and Chopart methods. Cut C 15 shows an 



amputation of the instep with all the tarsals removed, a part of 
the astragalus and the entire os-calcis retained and kept in their 
normal relations, a very unusual occurrence. 

The remaining plantar surfaces of each of these amputations 
are of a character to permit the application of the weight of the 
wearer on them. 

Cuts C 16 and C 17 show instep amputations in which the heels 
have retracted slightly, but not so much so as to prohibit the ap¬ 
plication of weight to the remaining plantar surfaces. 

Practical Prothesis. —The only artificial limb that has ever been 
devised that adequately meets the needs of any of the above instep 
amputations is illustrated in Cut C 18. A half leg, or front, in¬ 
cluding the core of the foot, is made of aluminum, without articula¬ 
tion at the ankle. The rear half is made of leather, shaped to 
incase the leg and the aluminum shell and hold the. appliance in 
place, as shown in Cut C 19. The sole of the foot, including the 












32 


A. A. Marks , Artificial Limbs , iVew For& City. 


toes, is made of rubber with a spring mattress as described in 
Chapter II. Comfortable bearings are provided by proper fittings 




and suitable linings. The pressure needed to secure firmness is 
distributed over the entire leg from the ankle to the knee; with this 


/ 



Cut C 18. Cut C 19. 


leg the wearer can rise on the ball of the foot without endangering 
the amputated surfaces or straining the ankle joint. The shin* 










A. A. Marks, Artificial Limbs, New Ywlc City. 


33 


bone is protected by the aluminum shell on the front, and, when 
dressed, presents an appearance very close to nature. When there 
is a tendency for the heel to retract, the leather sheath at the back 
is re-enforced with metal shaped to hold the heel down to its proper 
place. 

This artificial leg can be worn without inconvenience or pain. 
The wearer walks gracefully, striking the heel first, then rolling on 



Cut C 20. Cut C 21. 


the sole until the ball is reached, and then rising on the ball he 
receives assistance in walking. Cut C 20 shows the leg applied and 
the wearer seated. Cut C 21 shows the leg applied with the shoe 
on and the wearer walking with the weight on the ball of the foot, 
similar to the position taken by the natural foot when in the act of 
throwing the body forward. 

The method of meeting instep amputations, as just described, 
possesses many merits aside from those to which attention has been 

called. 

Retracted Heels. —Cuts C 22, C 23, C 24, show amputations in 
which the heels are retracted so that the amputated surfaces are 
directly under the legs, where the weight must be applied if the 
bearings are to be at the ends. These are unfortunate conditions. 
An artificial leg cannot be applied to a stump under such condi¬ 
tions that will permit any pressure on the scarred extremity; the 
weight, therefore, must be placed immediately below the knee or 
about the thigh. 








34 


A. A. Marks , Artificial Limbs, New York City. 



A limb constructed on the plan shown in Cut C 25 is adaptable 
for some stumps with retracted heels; the rear half is made of 



Cut C 25. 


Cut C 26. 


metal, the front of leather, capable of being laced. This permits 
close fittings about the heel and tends to force it back to its proper 













A. A. Maries, Artificial Limbs, New York City. 


35 


position. If the sides of the leg are sloping, the fitting can be such 
as to apply all the weight on the leg immediately below the knee. 
Cut 0 26 shows the leg applied and the wearer seated. 

If the sides of a leg do not slope sufficiently to prevent settling 
into the artificial leg socket, it is necessary to introduce an annular 
top and possibly knee joints and thigh support. The annular top 
can be applied to a leg constructed as described; it then has the 
appearance of Cut C 27. It can also be applied to a leg constructed 



Cut C 27. . Cut C 28. 


on the plan of C 25. Knee joints and thigh support can likewise 
be applied to a leg constructed on the plan of either C 18 or C 
25. Cut C 28 shows such additions applied to C 18 leg. When the 
annular top is employed the support is calculated to be localized 
immediately below the knee. The leg is opened from the rear and 
the stump inserted; the annular top is laced firmly and the leather 
sheath is pulled over the entire apparatus and laced in front. 
WTien the knee joint and thigh support are required, as shown in 
Cut C 28, the lower section of the leg is made of aluminum, with 
the rear sheath of leather. The thigh part incases the natural 
thigh and holds it with sufficient firmness to carry the weight above 
the knee and so prevent the leg from slipping in the socket. 

Aluminum Sockets. —The utilization of aluminum in the con¬ 
struction of artificial legs for instep amputations is especially 
advantageous. It can be worked to a very slight thickness, thus 
adding but little to the diameters of the large stump that it 









36 


A. A. Marks, Artificial Limbs, New York City. 


incases. A wood socket would require a thickness of at least half 
an inch on each side, thus making the leg conspicuously bulky 
and objectionable. 

During the past few years we have made many experiments 
looking to the general application of aluminum in the construc¬ 
tion of artificial limbs for upper amputations, but have met with 
disappointment except in ankle-joint and partial-foot amputations. 
The characteristics of aluminum are low specific gravity and com¬ 
parative strength. Its weight is the least of all metals (one-quarter 
that of silver). Its strength is comparable with that of copper. It 
will not corrode when exposed to fresh water or to a moist atmos¬ 
phere. 

We desire to correct the prevalent impression often expressed in 
the remark that aluminum is “ lighter than cork and stronger than 
steel.” As a matter of fact aluminum will sink in water, whereas 
cork or wood will float; it is therefore heavier and although 
aluminum is strong, it has but a fractional part of the strength of 
straight-grained wood. Its use in artificial legs is, therefore, nar¬ 
rowed down to sockets for long and large stumps, where the 
minimizing of bulk is an important feature. 

We hold United States patents on artificial limbs with alumi¬ 
num sockets, and if we could make satisfactory use of that metal 
for general purposes we would unhesitatingly do so. 



CHAPTER IV 

ANKLE-JOINT AMPUTATIONS 


Tibio-Tarsal Stumps. —Amputations through the ankle articula¬ 
tions with or without the maleoli, flaps formed of heel tissues, 
provide stumps that can be fitted with artificial legs in an ad¬ 
vantageous way. Surgeons call these amputations tibio-tarsal or 
Symes, and if the os-calcis is retained and secured at the extremity 
of the tibia, it is known as Pirogofi’s. 

Usually ankle-joint amputations produce stumps that admit of 
weight being taken on their extremities. If cicatrices are on the 



Cut D 2 . 


Cut D 1, 


bearing surfaces or nerve complications are present, they become 
non-end-bearing and artificial limbs must be applied that permit no 
pressure or contact on the tender extremities. 

End-Bearing. —Cuts D 1 to D 6 show end-bearing tibio-tarsal 
stumps, with flaps favorable for the application of pressure and 
with cicatrices well away from the bearing surfaces. Cut D 7 illus¬ 
trates an artificial leg suitable for any of these types; Cut I) 8 
shows it applied with the wearer seated. Cut D 9 shows a Pirogofi 
stump with a suitable leg, patterned after style D 7. Cut D 10 
shows the leg applied and the foot covered with stocking and shoe. 
Cut I) 11 shows the wearer fully dressed. In walking his step is 


37 






38 


A. A. Marks, Artificial Limbs, New York City. 



Cut D 3. 


Cut D 4. 





Cut D 6. 


graceful, the foot imitates nature, there is no limping, and he is 
limply equipped to engage in any occupation, even the most la¬ 
borious. 














A. A. Maries, Artificial Limbs , New York City. 


39 



Cut D 9. Cut DIO. Cut Dll. 


Construction of Suitable Artificial Leg. —The construction of 
D 7 style is simple. The front, which is the resisting part, and the 
core of the foot, are cast in aluminum, the interior surface being 















40 


A. A. Maries, Artificial Limbs, New York City, 


formed to receive tlie anterior surface of the leg from the knee 
down. It is so fitted that pressure will be distributed over the 
front area, the shin bone and tender parts of the leg being 
protected and not allowed to bear pressure. The rear part is of 
leather, shaped to fit the calf and the back of the leg. It is secured 
at its lower end to the aluminum socket, and when the stump is in 
place it incases the whole apparatus from the knee down, holding 
the leg in place with firmness, the pressure being regulated by 
lacing. The foot is of sponge rubber, re-enforced with spring mat¬ 
tress as explained in Chapter II. Weight is taken by the end of 



Cut D 12. Cut D 13. 


the stc«mp resting on a surface of proper shape, covered by a suit¬ 
able pad. The strains resulting from rising on the ball of the foot 
are not permitted to come on the stump; they are distributed over 
the leg, about the sides of the shin from the knee to the ankle. A 
stocking and shoe are drawn over the foot, and the apparatus is a 
counterpart in appearance to the sound leg. 

This style of leg for ankle-joint amputation has received the 
most complimentary comments; it has given great satisfaction to 
those who have worn it; and it has been quite generally adopted. 

Occasionally conditions require the construction of a limb in a 
manner reverse to that just described, the stump is admitted from 
the front instead of the rear. In such cases limbs are built on the 
plan illustrated in Cut D 12. The construction is practically the 
same as D 7, except that the metal socket is placed at the back and 
the leather lace in front. The shin bone is protected by a padded 















A. A. Marks, Artificial Limbs, New York City. 


41 


loose fly-piece over which the lacing passes. Cut D 13 illustrates 
the leg applied. 

If the end of the stump is small and has no prominences on the 
side, the socket and core of the foot, which are integrally one piece, 
are carved from a block of wood the grain of which curves on the 
line of greatest strains. When the end of the stump is large and it 
is desired to incase it in a socket of minimum thickness, aluminum 
must be employed for reasons given. 

Partially End-Bearing. —If only a part of the weight of the 
wearer can be borne on the end of the stump the top of the socket 
must be made annular and fitted so that it will impinge against the 
sloping part of the leg below the knee. Cuts D 14 and D 16 



Cut D14. * Cut D15. 


illustrate suitable legs for the same and Cuts I) 15 and I) 17 
show them applied. It is obvious that a stump, being inserted 
from the top of the socket of either, will not enter further than the 
top of the socket will permit, and this is just far enough to limit 
pressure on the end or to avoid it altogether. When pressure can 
be taken on the end, it is regulated by the thickness of the pad 
placed in the bottom of the socket on which the end of the stump 

rests. • 

A socket that admits the stump from the front, as in Cuts D 12 
and D 14, is objectionable when the end of the stump is very large. 
The material necessary for strength is on the sides of the stump 
and increases the diameter of the ankle. It also affords but little 













42 


A. A. Maries, Artificial Limbs , New Yorlc City. 


protection to the sharp or sensitive shin bone. Styles D 7 and D 
16 are not open to this objection, but give a smooth, unbroken 



front, which can be neatly dressed; they are lighter and stronger 
than D 12 or D 14, because the strain resulting from rising on the 
ball of the foot is carried forward from the point of contact to a 
point on line with the front of the leg: and as this point is usually 
halfway between the ball and the heel the strain is one-half of that 
applied in D 12, which throws the strain from the ball to the rear 
of the heel. For this reason the material on the sides of the stump 
and on the rear of the leg has to be as thick again as the material 
on the sides and front of the D 7. Hence the difference in weight. 

Sensitive Ends. —There are tibio-tarsal stumps that are so 
sensitive at the extremities that no pressure whatever can be 
tolerated either on the ends or at the sides of the ends. Notwith¬ 
standing this condition, artificial limbs can be applied that will be 
helpful and comfortable. Cuts D 18, D 19, and D 20 represent 
stumps of this character. 

If the surfaces immediately below the knee are sufficiently slop¬ 
ing to* offer resistance, D 14 or D 16 leg can be used, the pressure 
being placed on the sides of the upper half of the leg immediately 
below the knee. The stump from calf down hangs in space. 

When a leg and stump are nearly uniform in size, the sides being 
parallel or nearly so, an artificial leg with knee joints and thigh 
piece must be used. Cut D 21 represents a leg suitable for such a 
case. Cut D 22 shows the same with knee flexed and sheath un- 








A. A. Marks, Artificial Limbs, New York City. 


43 



Cut D 21. 




Cut D 20. 



Cut D 22. 


laced. The lower section is made of wood or aluminum, as the 
conditions of the stump demand. The rubber foot is attached in 
the usual way, and the leather sheath passes from the rear to the 








44 


A. A. Marks, Artificial Limbs, New York City . 


front, holding the stump in place. The weight of the wearer is 
supported by side joints connecting the thigh parts with the lewer 
portions. 

Cuts D 23 and D 24 illustrate the front and side views of a leg 
constructed in a similar manner. It is fitted to receive the leg and 
stump from the front instead of the rear; it contains no important 
advantage in construction, but is preferred by some persons. 

Side joints and thigh supports are essential when stumps cannot 



Cut D 23. Cut D 24. 


be supported on the sloping surfaces just below the knees, and when 
they are liable to become sensitive and irritable on account of 
impaired vitality. 

Peg Legs. —Ankle-joint stumps should never use peg legs except 
when they need disciplining or shrinking. Some stumps with 
extremely sensitive ends, on which pressure cannot be immediately 
applied, give promise of improvement in course of time. There are 
also stumps that are cedematous—made up with soft, flaccid tissue 
which will pass away in a brief period. In such cases, an inex¬ 
pensive peg leg can be used to advantage. One may stump about 
on a peg leg applied to a stump reaching to the ankle joint, much 
the same as one who uses a peg leg on an upper amputation, but, 
having no foot, its functions are limited to that of a support. 






CHAPTER V 

BELOW-KNEE AMPUTATIONS 


Long Tibial Stumps.—A n amputation at any point above the 
ankle and below the knee produces a tibial stump, so termed by the 
surgical profession, because the tibia or shin bone has partly been 
saved. 

Enlarged Non-End-Bearing.—C ut E 1 illustrates a stump reach¬ 
ing close to the ankle joint. The extremity, as is usual in long 
stumps, is poorly protected and incapable of bearing pressure, and. 



A. A. MARKS, N. V 


CutEt 



Cut E 2. 


on account of a slight enlargment at the end, an artificial leg must 
be made so that the stump can be placed in the socket from the 
front or rear instead of being inserted at the top. Cut E 2 repre¬ 
sents an artificial leg especially adapted to stumps of this descrip¬ 
tion; it is shown applied and the wearer seated. It has a socket 
that incases the rear half of the stump, with a front of leather 
that can be laced. The rubber foot with spring mattress is con¬ 
structed as described in Chapter II, and at the top of the socket 
are steel joints connecting the thigh supporter. The fitting of the 
leg avoids any weight or pressure on the extremity of the stump 
or near the end, and no pressure is applied at any point below the 
junction of the middle and lower thirds. Above this it is graduated 

45 






40 


A. A. Marks , Artificial Limbs , New York City. 


to the knee, where the greatest amount of pressure is applied, the 
interior sloping surface below the knee carrying most of the weight. 
The anterior prominences of the shin bone and the exterior 
prominence of the fibula are given ample room, so that no contact 
is applied; the interior sloping surfaces below the knee carry most 
of th6 weight, the supporter above the knee carrying its share. 

No Pressure at the Popliteal Space. —It is most important to 
avoid pressure at the back of the knee in long stumps. The pop¬ 
liteal space is the vascular area of the leg, and any undue pressure 
will interfere with the circulation and impoverish or strangulate 
the end of the stump. 

The absence of ankle articulation in a leg for a long tibial stump 
affords an opportunity to give ample space for the end without 



visibly increasing the external dimensions of the ankle. The rub¬ 
ber foot with spring mattress and yielding heel and toe provides 
every requisite for easy, lifelike, and noiseless walking without 
complicated connections. The absence of such connecting parts 
avoids the necessity of making the leg an inch or two longer than 
the natural one as is often necessary to obtain space for ankle 
mechanism used in other systems. 

Artificial legs with wooden articulating feet for stumps that 
reach to any point in the lower third of the leg are impracticable. 
The ends of long tibial stumps are sensitive, easily irritated, and 
poorly nourished, and the slightest contact will cause abrasion, 
frequently necessitating reamputations,. 

Tapering STUMPs.-duts E 3, E 4, E 5, and E 6 illustrate long 
tibial stumps. Legs for such amputations must be constructed so 














A. A. Maries, Artificial Limbs, New York City. 


47 



Cut E 5. Cut E 6. 


there will be ample room for the extremities. In other words, the 
ends are suspended in space. As these stumps are tapering to the 



Cut E 7. Cut E 8. 


ends they can be inserted from the tops of the sockets. The socket 
is hollowed out near the bottom of the heel and an abundance oi 


















48 A. A. Marks, Artificial Limbs , New York City. 


Toom provided, allowing a wholesome circulation of air; the exterior 
diameters of the leg are not large enough to be conspicuous. The 



leg socket and foot core are connected by an aluminum sheath 
riveted to each part in the most secure way. 



The rubber foot is attached to the core and the leg is finished so 
Ihe exudations from the extremity of the stump cannot possibly 
impair the strength of the connected parts. 










A. A. Marks, Artificial Limbs , New York City. 


49 


Cuts E 7 and E 8 show sectional views of a leg for a long 
tibial stump; the foot and leg parts are so secured that they 



are practically one. This method of construction admits of 




excavating the socket well into the foot so as to provide 
ample air space. Substantial legs for such stumps cannot be made 


































50 


A. A. Marks , Artificial Limbs , New York City . 


with ankle articulations, for cords, springs and bolts require 
space needed by the stumps. As metal becomes corroded by the 
exudations of the stumps, wood is the only material which will 
withstand these destructive agencies. 

Ordinary and Short Tibial Stumps. —No difficulties attend the 
fitting of an artificial leg to a tibial stump reaching to any point 




Cut E 17. Cut E 18. 

between the junction of the middle and lower thirds and the knee, 
when the knee joint is mobile to not less than two-thirds of the 
normal range. Cuts E 9 to E 16 are typical below-knee stumps of 
a variety of lengths and conditions relative to flaps, cicatrices, etc. 
The location of the cicatrices and the character of the flaps hav^ 
little importance in non-end-bearing stumps. 

Artificial Leg for Tibial Stump.—A leg suitable for a stump of 
two inches or more in length, with the knee articulating through a 
range of 90 degrees or more, is shown in Cut E 17. Cut E 18 shows 
it applied with the wearer standing. Cut E 19 shows it with the 
wearer seated. The action of the knee joint is clearly presented. 






A. A. Marks, Artificial Limbs , New York City. 


51 


Construction. —The leg consists of four parts: the foot, the 
leg, which fills the space between the foot and the knee; the knee 
joints, and the thigh piece or that part that incases the natural 
thigh. As the foot has been explained in Chapter II it now re¬ 
mains to describe in detail the other parts. 

Socket. —The socket that receives the stump is made from willow 
or basswood, which is excavated to accommodate the stump. Bear¬ 
ings are permitted at places of toleration. No pressure whatever 
is put on the vascular parts of the stump or on sensitive or 
prominent bones. The end of the stump is usually required to hang 



Cut E 19. Cut E 20. 


free in space. The exterior of the leg is shaped to as near the 
natural form as the stump will admit. It is strongly banded and 
covered. The surface is enameled with a waterproof preparation 
having a soft flesh tint. Knee joints are of the ginglymoid pat¬ 
tern, and as recently improved have very durable wearing surfaces. 
The thigh piece is made of substantial leather shaped to the con¬ 
tours of the thigh. 

Knee Connection. —Cut E 20 represents the upper section of the 
leg and the lower section of the thigh piece, with the knee joints 
disconnected at their articulations; aa are the screws that hold the 
bolts bb in place; cc are the bushings that work on the bolts and 
receive the wear; a lacing is used to regulate the action of the 
knee. The mechanical parts of the knee joints are completely 
illustrated in Cut E 21. 

Steel Joints.— Side joints, sometimes called hinge or ginglymoid 
joints, are used in legs for amputations below the knees. They are 
more durable and substantial when one of the parts is placed 












52 


A. A. Marks, Artificial Limbs, New York City . 


between the lips of the other and the two connected with bolts and 
screws. 

It is unmechanical and not lasting to place one section of a 
joint by the side of the other, holding them together by a screw, as 
is done by some manufacturers. Such joints wear irregularly side- 
wise and have a wabbling motion after limited service. This would 
not occur if the lateral strains on the upper sections could be kept 
the same at all times; but lateral pressure, causing unequal wear 
at the bearings, is brought about by contracting the thigh by 
lacing, in order to compress an emaciated thigh or distending it to 



Cut E 21. 



Cut E 22. 



Cut E 23. 


accommodate an enlarged one. These difficulties are only avoided 
by having one of the elements of the joints work between the lips 
of the other. 

The greatest wear on any joint is on the bolt that holds the parts 
together, and as the attrition is the greatest when the wearer’s 
weight is directly over the knee and becomes less as the knee is 
flexed, the bolt must necessarily wear irregularly. As the wearing 
surface on the bolt was formerly limited to the thickness of the 
section that worked on it, the wear was necessarily very rapid. 




















A. A. Marks, Artificial Lirribs, New York City. 


53 


The object of the improved joint is to increase the wearing sur¬ 
face as much as possible and to make the wearing parts independent 
and removable. They can then be highly tempered and the non¬ 
wearing parts left untempered, so that the supporting parts will not 
become friable. 

The wearing surfaces are increased more than double. They 
cover the entire surface of the bolt, and the inferior surfaces of the 
holes in the lips of the lower part. Cut E 21 shows the mechanism 
very clearly. AA is the upper part; BB the lower part; C is a 
long bushing which passes through the two lips of the lower part 
and the one of the upper; the lug D holds the bushing immovably 
fixed to the upper part. The bolt B passes through the long bushing 
and becomes immovably fixed to the lower part by means of a stop 
pin, which is fastened to the hub of the lower part, and fits a 
recess made in the head of the bolt. The screw A holds the bolt 
in place and clamps the joint. 

A glance at the section, Cut E 22, will show how these parts work 
together. Every movement of the joint causes the long bushing 
to revolve about the surface of the bolt and in the lips of the lower 
part. This mechanism prevents any wear from taking place on 
either the upper or lower parts, and distributes what does take place 
over the entire area of the bolt. The bushing and bolt are made 
very hard, and can be removed and replaced with new ones at any 
time that may be desirable. Cut E 23 shows a side view of the 
entire joints and ready to be attached to the leg. 

Ball-bearing Joints. —It has always been a mooted question as 
to the advantage of ball bearings in artificial limb joints. We are 
not prepared to say that they are better than removable bushings. 
We make both and the client can have either at no advance in price 
of limb. 

Our method is to use steel balls of large diameters; these travel 
in a race on one face of the upper joint, held in place by a bolt 
with race under its head. This bolt is held immovable by a set screw. 

Thigh Part. —The thigh part of the leg is made of durable oak- 
tanned russet leather, formed to the shape of the thigh, and suitably 
lined inside. There are several methods by which it is made to 
compress the thigh; buckles and straps are sometimes used; metallic 
clamps are occasionally preferred; but the greatest number of limb- 
wearers find the lacing method the most satisfactory, as it permits 
uniform adjustments and is neat and durable. 

Lacing Methods. —Cut E 24 shows the double-eyelet method. A 
row of eyelets is placed on each front edge, and a strong buckskin 
lacing passed through them. This method has been in vogue for 
many years and is still preferred by many wearers. 

Cut E 25 shows the lacing system more generally used at the 
present time. A row of hooks is placed on one edge and a row of 
eyelets on the other. On removing the leg the loops of the lacing 
are simply slipped off the hooks, the string remaining in the eyelet 
holes. When the leg is put on, the loops are put over the hooks and 
the cord is tightly drawn. Some wearers wish hooks on each edge. 



54 


A. A. Marks, Artificial Limbs , New York City. 


the same as on shoes. When this is wanted it should be specified 
in the order. 

Cut E 26 shows a device for rapid application. A row of studs 
is placed on one edge of the thigh piece, and a row of eyelets on 
the other; a separate piece of leather has also a row of eyelets and a 



row of studs. This is laced to one side of the thigh piece and 
buttoned to the other; the lacing can be adjusted once for all. On 
removing the leg one side is unbuttoned, and the other remains 
laced, as shown in Cut E 27. 

Check Strap. —The lacing at the back of the knee checks the 
knee action and is regulated by the wearer. It is a very strong 
leather thong, passing from the thigh piece to the leg part, as in 
Cut E 20. The more the thong is tightened the less becomes the 
















A. A. Maries , Artificial Limbs , New York City. 


55 


motion in the knee, and the more weight will be placed on the ball 
of the foot and less at the heel. 

The stump, in all cases, is inserted into the leg socket; the thigh 
piece is drawn around the thigh and laced tight enough to hold the 
leg firmly in place. The stump enters the socket comfortably. 
Bearings are only admitted about the sloping part immediately 
below the knee; the anterior surface of the tibia is always accom¬ 
modated by a channel; the bony prominence of the fibula is pro¬ 
vided for by a cavity; and the end of the stump hangs free in 
space, receiving no pressure whatever, either on the sides or at the 
end, except when conditions will permit. 

Sensitive Stumps. —In cases of extreme sensitiveness the weight 
can be carried entirely above the knee, and the stump is only 



permitted to perform the function of moving the lower leg forward 
and backward. 

Non-End-Bearing and End-Bearing. —Weight can rarely be 
applied to the end of a tibial stump, and only when the end is pro¬ 
tected by bone flap or periosteal flap and well covered with muscle 
tissue. When such favorable conditions exist an end-bearing pad 
is placed in the socket of the leg, the thickness of which is adjus¬ 
table, so as to increase or decrease the amount of pressure on the 
extremity. The wearer, when dressed either with or without the 
end-bearing pad, is able to walk, run, sit, or lie down. Every 
posture will have the semblance of nature, every movement will be 






56 


A. A. Marks, Artificial Limbs, New York City. 


made with surprising naturalness. The loss of the natural leg is 
absolutely concealed, and the substitution by the artificial restores 
the wearer to his usefulness. 

Thiguless Legs. —Artificial legs for tibial stumps are sometimes 
made without knee joints and thigh pieces, dependence being 



Cut E 29. Cut E 30. 

placed upon the socket when supporting the weight of the wearer, 
and resisting such lateral strains as may occasionally be brought 
upon the leg. Such a leg is shown in Cut E 28. From the knee 
down its construction is much the same as leg E 17. The socket is 
made of wood excavated to receive the stump properly. The foot 
is of sponge rubber with spring mattress, and the leg is covered 
substantially and finished in flesh-colored enamel. Straps at¬ 
tached to the leg in the region of the calf are made to pass around 
the thigh immediately above the knee cap. If these do not hold 
the leg firmly in place auxiliary straps are attached, to pass over 
one or both shoulders. 

Some manufacturers advocate the use of thighless legs whether 
the stumps are long or short, and pay little attention to the 
character of the extremities. They attach more importance to the 
absence of thigh constriction than they do to the danger of abra¬ 
sions on the stump or injury to the extremity. 

While it is true that there are many cases in which thighless legs 





A. A. Marks , Artificial Limbs, New York City. 


57 


are applied and worn with evident satisfaction, it must be clear 
that the absence of a thigh supporter entails a sacrifice of efficiency 
and protection. Metal knee joints and thigh supporters perform 
the very important functions of protecting stumps, avoiding side 
strains, injuries from concussions, and the tearing of cicatrices. 
Cut E 29 shows a thighless leg applied, the wearer standing; Cut 
E 30 the rear view of the same, Cut E 31 the side view, and Cut E 



Cut E 31. 


Cut E 32. 


32 the wearer seated. These cuts show the operations of the leg 
and the action of the suspenders. 

Dangers. —When the wearer is standing with his weight on an 
artificial leg of the thighless type the stump has to carry all his 
weight. This usually comes upon the sloping parts immediately 
below the knee. If the wearer makes a misstep and recovers him¬ 
self by his artificial leg the stump will receive a strain; if he 
carries a heavy weight his stump must resist a force that tends 
to push it further into the socket; and unless the sides of the 
stump are sufficiently sloping to oppose this there will be danger 
of injury to the flap and cicatrix. 

One of the chief objections to the thighless leg is the difficulty 
that arises when the stump changes in size, as it so often does. If 
the stump becomes emaciated the socket of the artificial leg must 
be filled up to compensate for the loss of flesh, and if the emacia- 

















58 A. A. Marks, Artificial Limbs, New York City. 


tion is not uniform there will be considerable difficulty in padding 
the inner surfaces of the socket so as to avoid pressure on delicate 
parts. 

One should never experiment with the thighless leg unless the 
stump has been accustomed to wearing an artificial leg for a 
considerable length of time, and has become so thoroughly dis^ 
ciplined that further changes are not likely to occur. Those who 
insist on wearing thighless artificial legs, who have worn them from 
choice, and who have their stumps sufficiently disciplined will be 
accommodated in their wishes. 

Slip Sockets versus Wood Sockets. —Rival manufacturers have 
said and published much about the slip or sliding socket and con¬ 
siderable curiosity has been aroused among limb-wearers as to the 
merits of the idea. As the slip socket applies almost exclusively to 
artificial legs for tibial stumps, the subject may be introduced and 
discussed at this time. 

We have given the matter much thought and subjected it to a 
most rigid investigation. We have, moreover, submitted the 
scheme to many tests and have conferred with several hundred 
persons who had worn slip sockets. Our investigations were 
planned to determine whether the scheme had sufficient merit to 
warrant us in adapting it to our work. 

We have long been aware that a well-fitting socket of wood or 
any smooth hard material will never chafe the stump, even if the 
stump is permitted to move in it. On the other hand we have 
known that any socket made of a yielding material like leather 
will, frcm the constant pressure and heat of the stump, change in 
form a*i J. cease to be comfortable. Perspiration and other exuda¬ 
tions from the stump have deteriorating effect on any material 
that permits absorption. All exudations from the stump becomes 
putrid in a very short time and cause offensive odors and bring 
effete matter in contact with the skin. This almost invariably in¬ 
fects the stump and causes unhealthy conditions. A hard highly 
polished surface is more pleasant for the stump than any form of 
soft yielding cushions. 

The slip-socket idea is somewhat antiquated. In 1866 the United 
States Patent Office issued letters patent No. 55,645 to Daniel 
Gilson, covering the principle of the slip socket, consisting of a 
leather socket molded on a cast of the stump, then placed inside the 
artificial leg, and held in place by springs. Its object was to 
obviate the movement of the stump in the socket and to localize 
all the motion between the stump socket and the socket of the 
artificial leg. It was very soon found that the stump socket, being 
tightly held to the stump at all times, constricted the blood vessels 
and caused much trouble. The inventor, being conscientious, 
abandoned the manufacture of legs on that plan. 

Quite recently, however, the slip-socket feature has been revived, 
and some insignificant modifications made on the original Gilson 
model, mainly in the mode of suspending the inner or slip socket. 
The idea has been extensively advertised and a considerable num- 



A. A. Marks, Artificial Limbs, New York City. 


59 


ber put in use. We have records of many of these cases, and we 
feel it a duty to the maimed community to disclose the effects a slip 
socket has had on many stumps. 

It must be remembered that in order to carry out the principle 
of the slip or sliding socket the stump must remain under constant 
pressure, great enough to avoid any motion or friction between the 
stump and the socket. All the slipping and sliding due to the 
intermittent application of weight, as in walking, takes place 
between the slip socket and the socket of the artificial leg. Few 
stumps can tolerate this constant pressure without the blood vessels 
becoming strangulated; we therefore do all we can to dissuade 
clients from risking such a dangerous experiment. 

Slipping of the Stump Desirable. —There is nothing so pleasant 
to a wearer of an artificial limb, no matter what kind of a leg he 
is wearing, as to be able to lift his stump from its bearings and 
give it a chance to rest and recover, exactly as one does when 
standing on natural legs. He throws his weight on one leg for a 
while and then on the other, and in this way both legs in their turn 
become rested. Every wearer of a wood-socket limb invariably 
does this. It is a source of comfort and relief; but it cannot be 
done with the slip socket, which clings to the stump like a leech. 

The socket that is made to fit the stump so that pressure will be 
uniformly distributed over all its parts, is neither scientific nor 
tolerable. Every stump has parts that will bear pressure and parts 
that will not stand any at all. Parts where blood vessels and nerves 
are clustered, where the bones are close to the surface and poorly 
protected by tissue, must be prevented from impact. A flexible 
socket has a tendency to assume the shape of the stump and dis¬ 
tribute the pressure uniformly, bringing as much on the forbidden 
parts as elsewhere. Therefore the flexible socket is a dangerous 
one to wear. 

A socket that fits properly will never chafe the stump, no matter 
how much it may slip, slide, or move in it. This is a fact ascer¬ 
tained by most careful, thoughtful, and conscientious investigation, 
and cannot be successfully controverted. We know from very 
ample experience and inquiry that there is no socket so pleasant to 
wear, so light, so cool, and so healthful for the stump as the wooden 
one, when properly and scientifically fitted. No material has ever 
given such permanently good results as wood. 

An Instance. —Mr. Frank M. Talbot met with a railroad accident 
in 1890 which crushed his leg. Amputation was made below the 
knee, leaving a stump four inches in length. He obtained an 
artificial leg with wooden socket, which he wore for some time 
with efficiency. His stump, following the usual course, emaciated, 
and instead of having the leg refitted he was prevailed upon to 
order a new leg with a slip socket. He wore the leg for a while, 
but gradually the end of his stump became congested and painful. 
He went to his slip-socket leg-maker for relief, but was told that 
his stump was diseased and nothing but medical or surgical treat¬ 
ment would help him. The stump grew worse; he called in a 



60 


A. A. Marks, Artificial Limbs , New York City. 


physician, who by medication brought it to a healthy condition, 
but put him on his back for a while. Shortly after he resumed 
wearing the slip-socket leg, the trouble recurred. He came to New 
York, and under the impression that his stump was diseased, con¬ 
sulted several prominent surgeons. All agreed that the stump had 
been strangulated by the artificial leg, and unless the cause was 
removed the bone would soon become infected and re-amputation 
would be necessary. 

Mr. Talbot called upon us, and on examination we found the end 
of the stump swollen and as blue as indigo. An abscess was form¬ 
ing. We told him that his trouble was due to pressure upon the 
blood vessels, and advised him to abandon the slip socket, and wear 
a wooden one, so fitted that it would not constrict the blood vessels 
nor permit any of the tender parts of the stump to take pressure. 
He yielded to our advice, and we made and applied a leg with 
wooden socket and our patent rubber foot. It was remarkable 
how quickly his stump recovered. As soon as the pressure was 
removed from the vascular parts, circulation was restored and the 
stump became healthy. This was eleven years ago and the stump 
at this writing is in a healthy condition, without the slightest 
indication of a recurrence of his trouble. We can cite hundreds of 
cases similar to this and will gladly furnish additional data to 
those desirous of investigating further. 

Waterproof Legs. —There are some occupations that require 
limb-wearers to stand in damp and wet places, exposing their 
artificial legs to moisture, much to their injury. Farmers, miners, 
builders, woodsmen, raftsmen, trappers, oystermen, fishermen, 
watchmen, sailors, stablemen, chauffeurs and a thousand Others 
are of this class. 

Our method of constructing artificial legs enables us to meet 
the requirements of these people as they have never been met before. 
The foot is of sponge rubber with spring mattress, it is perma¬ 
nently secured to the leg and the whole is covered with suitable 
material coated with a waterproof preparation. This method is 
secured by Letters-Patent July 9, 1912. 

Bathing Legs. —Persons who indulge in aquatic sports can use 
artificial legs of this kind; with them they can wade, bathe, or 
swim in salt or fresh water exactly as persons in possession of 
their natural limbs and without disclosing the fact that their 
limbs are other than those provided by nature. Cut E 7 is a 
sectional view on which waterproof legs are constructed. It 
will be seen that there are no parts that can be affected by 
moisture. The entire lower leg is capable of withstanding the 
severest strains and exposure. 

Shortened Thigh. —Complicated conditions in tibial amputa¬ 
tions frequently present themselves and require specially designed 
artificial limbs. Cut E 33 illustrates a case in point. The injury 
to the patient, necessitating the amputation of the leg below the 





A . A. Marks, Artificial Limbs, New York City. 


61 


knee, fractured the thigh and dislocated the hip. The femur 
became lapped and deflected and its head was permanently dis¬ 
placed. This occasioned a shortening of the thigh of several 
inches. In the artificial leg the shortening of the thigh was com¬ 



pensated for by lengthening below the knee. A leg constructed 
on the plan of E 17 is suitable for cases of this character. Its 
thigh piece is made to extend well up to the body and take in the 
gluteal folds and the entire external surface as far as the crest 
of the ilium, thus giving the necessary support to the fractured 
part. 

Cut E 34 illustrates a case of shortened thigh of the left leg 
while the right was amputated. It resulted from a railroad acci¬ 
dent which crushed the right foot and ankle and fractured the 
opposite thigh. The right foot was amputated at the junction of 
the lower and middle thirds. Despite every effort to bring about 
the correct union of the fractured femur of the left leg, the bones 
slipped, resulting in a shortening of the thigh by several inches. 
An artificial leg constructed on the plan of E 17 was applied. The 
leg from the knee down was as much shorter than the left as the 
thigh of the left was shorter than the right. 

In both these cases the artificial legs necessarily caused a dis¬ 
parity in the lengths of the legs from the knees down, but the 
differences were not noticeable, even when the wearers were seated, 










62 


A. A. Marks , Artificial Limbs , 2Vew ForA; City. 


except when closely scrutinized. In other respects there were no 
inconveniences experienced. 

In ordering an artificial leg every peculiarity of the sound leg 
as well as the partly amputated one should be brought to the 
attention of the manufacturer. 

The Lateral Adjusting Socket. —Changeable stumps are more 
frequent than generally known. By changeable stumps we mean 
those that remain large for a period and then became small and 
then large again. This characteristic is inherent in some stumps 
and cannot be controlled by any method of treatment. An 
artificial leg capable of being endured on a stump of this kind is 



Cut E 67. Cut E 68. 


usually made large enough to receive the stump when it is at 
its largest dimensions, and when at its smallest additional socks 
are worn, or linings are put in the socket. There is some in¬ 
convenience and annoyance incurred in this way of adjusting. 

Some manufacturers make sockets of leather, with lacings down 
the front, or rear, or both and claim that by drawing these lacings 
up or letting them out, the required adjustment can be made. 
It is easily seen that this method admits of adjustment from 
front to back only; the distance from side to side remains the 
same; the steel side joints, necessarily moving on the same axis, 
will not admit of any change in that direction. This is opposite 
to what it should be; if the distance from front to back is lessened 
there is increased pressure on the shin bone as well as on the 
blood vessel back of the knee. The shin bone cannot endure 








A. A. Marks, Artificial Limbs, New York City. 


63 


pressure and the blood vessels back of the knee, if constricted for 
a length of time, will suffer from interference with the circulation, 
and trouble in the end of the stump will follow. 

The Marks lateral adjustable socket admits of the adjustment 
in the right direction; this is made possible by giving the side 
joints an additional hinge so that they will move sidewise as 
well as front and back. With this hinge, and a socket slitted 
front and back, it is possible to draw the sides of the socket closer 
together or set them further apart, and still have the centers of 
motion in the knee joints work on the same axis. 

This method of constructing artificial legs with provisions for 



Cut E 69. Cut E 70. 


lateral adjustment has been applied to changeable stumps since 
1909. It has stood this thorough test and proved its efficiency in 
many cases. Patented July 9, 1912. 

Cuts E 67 and E 68 present front and rear views of a leg 
with socket wide enough to accommodate a large stump, and cuts 
E 69 and E 70 present the same leg front and rear views with the 
socket made smaller by drawing together the sides, thereby accom¬ 
modating the same stump when it has become smaller. 

Contracted Knee Joints. —Another class of leg stumps are those 
which are sufficiently long to control the knee movements of the 
artificial leg, but being partly contracted, the extension of the knee 
is somewhat limited, so that the use of the ordinary type of E 17 
leg is impossible, while the contraction is not sufficient to make the 
knee joint inoperative in controlling the artificial leg. 





64 


A. A. Maries , Artificial Limbs, New York City. 


Knee joints of tibial stumps become contracted either from the 
results of the injuries that occasioned their amputation, or, more 
frequently, from neglect in permitting the stumps to remain in 
semi-flexed positions during the convalescent periods. Cut E 39 



illustrates a partially contracted knee of a tibial stump which is 
capable of full flexion but of limited extension. 

An artificial leg on the plan of E 17 with a slight modification 
of the socket, as shown in Cut E 40, meets the requirements of the 
case. By referring to Cut E 41 it will be seen that the stump is 
received in the socket while in a semi-flexed position. The socket is 
so made as to bring constant and gentle pressure upon the ham¬ 
strings every time a step is taken. The object of this is to induce 
the breaking up of the contraction and eventually restore full knee 
motion. The artificial leg is provided with a lacing attachment 
that passes over the rear part of the stump. As the stump im¬ 
proves in extension this lacing strap is tightened and greater pres¬ 
sure brought upon the stump. 













A. A. Maries, Artificial Limbs , New York City. 


65 


Although a stump may be contracted to a considerable angle a leg 
of this character can be worn and the wearer enabled to get about 
m an advantageous way, concealing his loss, walking in a graceful 
manner, and dispensing with the use of crutches. 

We know of no more practical method for breaking up the con¬ 
traction m the hamstrings than wearing an artificial leg of this 
i 16 we ^ rer 13 Permitted to engage in his usual occupations 
while the work of restoration of the knee motion progresses. 
When the knee has become corrected and the stump can be ex¬ 
tended to a straight line, the socket on the artificial leg can be 
removed and the regular socket, similar to that shown in Cut E 
17, applied at a very slight expense. 

Cut E 41 shows the leg applied to a contracted stump and the 
wearer walking. Cut E 42 shows it with the wearer seated. The 



Cut E 41. Cut E 42. 


contraction of the hamstrings does not interfere with walking, 
standing, or sitting. 

Cut E 43 illustrates a tibial stump with a contraction of the 
hamstrings considerably greater than in the last case, so great as 
to prevent the knee from extending beyond a right angle with the 
thigh. Cut E 44 represents an artificial leg suitable for this case. 

A knee-bearing leg might be considered the more suitable, but 
when the fact is remembered that there is an angular motion in 
the knee, with the possibility of improvement, it is better to apply 
a leg that will keep up the action of the knee and bring a con¬ 
stantly increasing tension on the hamstrings. A leg constructed 















66 


A. A. Marks , Artificial Limbs, New York City. 


on the plan of that represented in Cut E 44 is made for this 
purpose. 

Hypertrophied Tibial Stump. —Amputations through the tibia 
are sometimes necessitated by hypertrophy, with induration of the 
foot and ankle, as in the case of elephantiasis. Such cases usually 



Cut E 43. 


Cut E 44. 


produce stumps that are much larger at their extremities than 
above, the extremities incapable of bearing pressure, and the sides 
able to tolerate only limited compression. Cut E 45 shows a stump 
of this character. It requires an artificial leg constructed upon 
the plan of E 46, with the rear open so as to receive the stump, the 
stump and socket are incased by a sheath holding the parts to¬ 
gether. Cut E 46 represents a side view of an artificial leg suitable 
for such cases. Cut E 47 presents the front view with leg applied. 

In all the complicated cases previously described, the method of 
constructing artificial legs with rubber feet and spring mattress is 
especially advantageous. Great strength is obtained, durability is 
secured with minimum weight and bulk about the enlarged 
extremity. 

Anchylosed Knee Tibial Stumps Extended. —Some tibial 
stumps are rigid when extended. That is, they cannot be flexed, 
owing to anchylosis of the knees resulting from the injuries that 












A. A. Maries , Artificial Limbs, New York City. 


67 





caused the amputations, impairment of the knee tendons, calcareous 
deposits in the articulations, and many other causes. If there is 
an absence of mobility in the knee and the stump is extended, an 












68 


A. A. Maries, Artificial Limbs , New York City. 


artificial leg must be constructed so that the artificial knee articula¬ 
tion will be independent of the natural knee and operate on the 
sides of the stump approximately at the points where the natural 
articulation takes place. Cuts E 48 and E 49 represent tibial 
stumps extended, with knee joints anchylosed. 

It will be observed that in Cut E 48 the sides of the stump and 
thigh are approximately parallel, or in other words they do not 
slope sufficiently to offer any sustaining surfaces. An artificial leg 




Cut E 50. Cut E 51. 

constructed on the plan of Cut E 50 is intended for a stump of 
this character. 

The top part of the thigh piece is annular and permits the stump 
and thigh to enter until the gluteal folds, the ischium, and the 
perineum come in contact with the top border of the socket, where 
the entire weight is applied, the same as if the amputation had 
been made in the middle of the thigh. Cut E 49 represents a 
stump the sides of which are tapering sufficiently to offer some 
opposition, sustaining in part the weight and lessening the amount 






A. A. Marks , Artificial Limbs , New York City. 


69 


of pressure on the top border of the socket. An artificial leg con¬ 
structed on the plan of E 51 will meet the requirements of this 
case. Both of the above artificial legs are made to articulate at 
the knees. 

The legs from the knees down are constructed practically the 
same as the E 17. The thigh piece is leather and wood; the rear 
of wood and the front of leather arranged for lacing, so that the 
required pressure will be brought upon the thigh to hold it in 
place. Leg E 50 differs from E 51 in the top of the socket, it be¬ 
ing annular with continuous border. It is held securely to the 
body by the lacing front, assisted by suspenders passing over the 
shoulders. 

The knee joints of these legs are of the hinge style as illustrated 
in Cut E 21. Articulation at the knee is limited by a check cord 



Cut E 52. Cut E 53. 


connecting the thigh and calf sections. Cut E 52 shows the leg 
applied, the wearer seated; and Cut E 53 shows it with the wearer 
standing. It will be seen that the knee articulation approximates 
very closely the action of the opposite leg and permits the wearer to 
stand, walk, sit, or kneel. 

Peg Legs.— Peg legs suitable for tibial stumps are oi three 
kinds. The simplest and least expensive is shown in Cut E 54. 
It consists of two wooden branches, one running up on the outside 
of the thigh, well up on the body, the other on the inner side reach¬ 
ing nearly to the crotch. 





















70 A. A. Marks, Artificial Limbs , New York City. 


These branches unite below % the point of bearing and continue 
to the ground, terminating in a rubber tip. A padded shelf is 
placed between the branches on which the knee rests when in a 
flexed position. The leg is held in place by leather straps passing 
around the thigh and body. 

Cut E 55 shows a peg leg without knee joint or thigh support 
suitable for a tibial stump. The socket is shaped to receive the 



Cut E 54. Cut E 55. Cut E 56. 


stump from the knee down in a comfortable way. The base termi¬ 
nates with a rubber tip, and straps necessary to hold the socket on 
the leg are connected with the leg and passed around the thigh 
immediately above the knee cap. When necessary, suspenders are 
attached to help carry the weight. 

Cut E 56 shows a peg leg suitable for a tibial stump constructed 
practically as E 17, except that there is no rubber foot, a rubber 
tip taking its place. 

Peg Legs Should Not be Used Permanently. —Peg legs are 
worn as temporary expedients, for disciplining stumps, or to bridge 
over an impecunious period. We know persons, however, of ample 
means who have reached advanced years, who from childhood have 













A. A. Marks , Artificial Limbs , New York City. 


11 


constantly worn peg legs, and doubtless will continue to do so, as 
long as they live. 

It is quite possible to stump around on peg legs and do much 
hard work with them. They are immeasurably better than 
crutches, but they are very far from rendering the services that 
can be obtained from artificial legs with sponge rubber feet. The 
foot is an essential factor in helpful easy walking, and a means of 
opposing strains required in carrying heavy weights, ascending or 
descending stairs or elevations, and in walking long distances. 

We disparage the use of peg legs, as we are keenly alive to the 
fact that they are inadequate to meet the demands that must be 
put upon them. Any form of peg leg that will keep the knee joint 
in a flexed position is liable to weaken the tendons of the knee, 
impair the knee movement, and limit its range of motion. They 
should, therefore, be used only as expedients. 

Ferrules for Peg Legs. —Cut E 57 represents an aluminum 
peg-leg ferrule and rubber tip. Cut E 58 represents the aluminum 
ferrule separate, and Cut E 59 represents a pure gum rubber tip 



Cut E 59. 


separate, which screws into the ferrule. Cuts represent one-quartei 
size. The ferrule is permanently fastened to the peg leg, and the 
rubber tip screws into it. 

Kubber Tip. —When the rubber tip wears down so that the metal 
ferrule touches the ground, it should be removed and a new one 
put in. The base of the rubber tip is 2 1-2 inches in diameter and 
the threaded shank is 1 1-2 inches in diameter. 

Suspenders. —Suspenders for artificial legs for tibial stumps are 
of many kinds. Most persons with long and healthy stumps do 
not use suspenders at all, and a very small number retain them 
after they have become accustomed to their artificial legs. 

As an aid for the beginner, however, we deem it advisable to put 
suspenders on every leg made for tibial amputation, whether the 
stump is long or short. 

Cut E 60 shows a double suspender for a tibial stump leg. It 





















72 


A. A. Marks, Artificial Limbs, New York City . 


consists of two-incli elastic webbing connected with the back of 
the thigh piece and running well up to the shoulder, where two 
non-elastic straps, each 11-2 inches wide, are attached which branch 
so as to pass over the shoulder. They are connected with the upper 
part of the thigh piece in front, and adjusted by clamp buckles 
with snaps. 

Cut £ 61 presents a simple yoke suspender preferred by women. 
It is made to fit the body immediately above and upon the hips. 



Cut E 60. Cut E 62. Cut E 63. 


It is seldom necessary to use shoulder straps. Straps running 
down from the belt connected with the upper part of the thigh 
piece are usually ample. 

Cut E 62 shows a yoke suspender similar to the last, but pro¬ 
vided with shoulder straps. Elastic straps buckled into the attach¬ 
ments connected with the thigh piece are used to fasten the yoke 
to the leg. This method is necessary for small hips and in cases 
where entire support from the hips or pressure about the loins or 
over the abdomen cannot be tolerated. 

The corset style is frequently preferred by women. It consists 
of strong elastic straps secured to the lower part of the corset, one 
in front and one at the back as shown in Cut E 63; they are 
buckled into straps secured to the upper part of the thigh piece. 





















A. A. Maries, Artificial Limbs, New York City . 


75 


part from the knee down is hollowed out to reduce the weight. 
The exterior dimensions are as close to those of the natural leg 
as conditions will admit. The foot is of rubber with spring mat¬ 
tress as previously described. 

Bolt J oint.— Cut F 6 shows the knee mechanism with the parts 
separated: a is the knee-bolt which holds the leg and thigh sec¬ 
tions together, forming an axis for the knee. It is flanged on 



Cut F 7. Cut F 8. 


one end and threaded on the other. When the bolt is passing 
through the metal ear which is riveted to the lower leg the head 
sinks into its bed and the threaded end screws into the ear riveted 
to the opposite side. The set screw b, placed into the flanged 
end, prevents the bolt from moving and working out; c is the 
check cord screw; d the check cord; g the spring piston; h the 
spiral spring; i the cylinder. The relations and functions of 
these parts can be understood from an examination of Cuts F 7 
and F 8, which show the leg with the knee extended and fully 
flexed. 

The action of the spring holds the leg at flexion when the 
wearer is seated, and urges the leg forward when walking. The 







76 


A. A. Marks , Artificial Limbs , New York City . 


range of articulation can be regulated by means of pads placed 
between the lower end of the check cord and the bridge under 
which it passes. These pads can be reached through the opening 
in the calf of the leg. The upper loops of the check cord rest in 



their respective channels and through them a steel screw is passed 
and set. 

The mechanism of the knee-bearing leg is very durable, and will 
stand severe use for years. 

Side Joint. —The center of motion being placed below the 
natural knee, causes a disparity in the lengths of the two thighs; 
only noticeable, however, when the wearer is seated and subjected 
to close scrutiny. The durability of the knee-joint mechanism in 
style of leg shown in Cut F 5 fully compensates for excessive 
length of thigh, moreover, this mechanism admits of the minimum 
width of the knee. The choice of style remains with the wearer; 
if he prefers the wide knee to the long thigh, and is willing to 
sacrifice durability, he can have the leg constructed with side 
joints, as represented in Cut F 9, the center of knee motion 
of which is brought to the sides of the knee by means of hinge 






A. A. Marks, Artificial Limbs, New York City . 


11 


joints, of the style shown in Cut E 23, page 52. The knee-check 
cord is practically the same as that represented in Cut F 6. Cut 
F 10 shows the leg applied, wearer seated with knees flexed. 

Peg Legs. —'Peg legs for knee-bearing stumps are of three kinds; 
and will be considered in their order: Cut F 11 shows the cheapest 
form of peg leg for a knee-bearing stump; its construction is of 



Cut F 11. Cut F 12. Cut JB 13. 


bent wood with metal ferrule, rubber tips, and leather strappings. 
Cut F 12 shows a peg leg with knee joint suitable for a knee-bearing 
stump. 

Cut F 13 shows a peg leg without knee articulation for knee¬ 
bearing stump. The upper parts, F 12 and F 13, made of wood 
and leather, fitted to receive the stump, which is held in place 
by lacing. 

The ends of peg legs are terminated by metal ferrules and 
rubber tips as described in Cuts E 57, E 58, and E 59, page 71. 

Incomplete Restoratives. —For reasons heretofore given, we 
do not advocate peg legs for knee-bearing stumps and only fur- 













78 


A. A. Maries, Artificial Limbs, New York City. 


nish them when they are especially ordered. It -is far better 
for a person to procure a complete artificial leg with rubber foot, 
with spring mattress, one that will possess all the elements neces¬ 
sary for helpful and convenient walking, even if he has to deny 
himself in other ways in order to obtain one. A peg leg is a make¬ 
shift, and will in all probability weaken or destroy what knee 
motion remains. 

Suspenders. —Suspenders suitable for knee-bearing legs are sub¬ 
stantially the same as those employed for tibial stump legs. The 
details are given in the preceding chapter. 



CHAPTER VH 

DISARTICULATED KNEE STUMPS 


End-Bearing and Non-End-Bearing Stumps. — Amputations 
through the articulations of the knees call for careful prothetical 
consideration. Stumps resulting from such amputations may be 
end-bearing or not; when they are covered with tissue flaps, free 
from cicatrices and nervous complications, they are end-bearing; 
if they are cicatrized, and sensitive, pressure must be applied else¬ 
where; if they are tapering to the ends or are broadened at the 




Cut G 2. 


extremities they must be treated accordingly. The presence, of 
the patella, securely united in the intercondylar space, will im¬ 
prove the character of the stump, but if it is not united it is 
doubtful if the end will tolerate any weight whatever. 

Fittings. —Artificial legs for knee-joint amputations must ad¬ 
mit of placing pressure only on parts capable of enduring it. 
Tender, delicate, sensitive, and irritable spots must be guarded, 
and non-end-bearing stumps must be provided with limbs that will 

79 

















80 


A. A. Marks, Artificial Limbs, New York City. 


take the weight at the ischial and perineal regions; if the sides 
of the stumps are sloping a share of the weight can be distributed 
over those parts. Sensitive condyles, bony prominences, and fascia 
must be properly cared for. 

Peculiarities of Stumps. —Cut G1 shows a type of stump result¬ 
ing from knee-joint amputations; the nodulous extremity due to 
the presence of condyles, together with ample coverings, provide 
desirable conditions. An artificial leg suitable for this stump 
is so fitted that the weight is carried on the end, which rests on 
a padded surface at the lower end of the socket, and held securely 
in place by the leather lacing. The shoulder suspension is greatly 
simplified when condyles are present in the stump. Cut G 2 shows 




a side view of a stump favorable for end pressure. Cut G 3 
shows a stump reaching to the knee, patella present and without 
cicatrices, thus admitting of end pressure. 

Cut G 4 shows a thigh stump reaching to the knee and ex¬ 
tremely well protected, with cicatrices at the rear and well away 
from the end; bunches of sensitive tissue hanging from the ex¬ 
tremity prevent the application of weight at that point. Cut G 5 
shows a thigh stump reaching to the knee with an end incapable 
of bearing pressure; the condyles and all the natural coverings 
of the bone were removed in the operation. Bunches of tissue 
and ganglia were gathered at the end back of the stump. The 
muscle tissue puckered considerably and the presence of cicatrices 
on and about the end prevents the application of weight there. 
Cut G 6 shows a stump reaching to the knee, condyles present, 
the extremity covered with integumentary folds, deep fissures and 





A. A. Marks, Artificial Limbs, New York City. 


81 


cicatrices, preventing the application of weight upon the ex¬ 
tremity. 

Most Favorable Conditions. —These examples develop the fol¬ 
lowing points: Stumps extending to the knee with nodulous ex¬ 
tremities, capable of bearing weight, are the most favorable of 
all knee-joint stumps. They result from amputations through the 



Cut G 5. Cut G 6. 


knee articulations, the condyles remaining untrimmed, or, if 
trimmed, the ends protected by bone and muscle flaps; the natural 
coverings to the bones permitted to remain on the articulating 
surfaces; the patellas, if present, firmly united to the end of the 
femur; flaps well carried to the posterior and the cicatrices some 
distance from the ends. Stumps possessing these favorable con¬ 
ditions can be efficiently accommodated with artificial legs that 
will minimize the pressure about their upper borders and simplify 
the mode of suspension. 

A stump reaching to the knee, with a nodulous extremity and 
incapable of bearing weight on the end, is capable of operating 
an artificial leg, but the means of attachment are necessarily more 
extensive and more severe than when the weight can be borne on 
the ends. 

Inability to bear weight on the extremities of knee-joint stumps 
is not always due to surgery. 

Sloughing, bone degeneration, hyperesthesia, etc., frequently 
occur despite the most careful precautions of the operator. 

Suitable Artificial Legs. —The foregoing cuts illustrate 
stumps that can be advantageously fitted with artificial legs con- 







82 


A. A. Marks, Artificial Limbs, New York City. 


structed upon plans of those shown in Cuts G 7 or G 8, according 
as the stump is tapering or straight, or whether the end can endure 
weight or not. The thigh of either leg is made partly of wood and 
partly of leather. The rear section is of wood, excavated to re¬ 
ceive the stump in the most comfortable way. The front portion 
is of leather arranged for lacing as shown. If the stump is 
tapering to the end there will be no advantage in having the 
front laced, the entire socket can be better constructed of wood. 

Cut G 7 illustrates a leg made to place a large amount of the 
weight of the wearer directly on the extremity of the stump. Cut 



Cut G 7. Cut G 8. 


G 8 shows a leg with annular top designed to hold the end of the 
stump away from the bottom of the socket, all the weight being 
distributed over the sides, above the knees and about the top 
borders of the socket. In both these styles every requirement 
for the comfort of the wearer and the efficiency of the leg is con¬ 
sidered. 

The stump socket of either leg is of proper size and shaped t<? 
receive the stump and carry the weight of the wearer. 








A. A. Marks, Artificial Limbs, New York City. 


83 


Both upper and lower sections are made of selected kiln-dried 
wood, carved to the shape of the stump with external proportions 
as near those of the natural leg as the conditions will admit. The 
lower leg is excavated to reduce weight. The foot is of rubber as 
heretofore described, and both leg and thigh are coverd with suit¬ 
able material properly enameled. The knee mechanism is the 
same as that illustrated in Cuts F 6 and F 7. 

Suspenders for legs for knee-joint amputations are the same 
as those applied to thigh amputations, and are fully treated in 
the following chapter. 

We point with pride to many thousand persons who walk on 
artificial legs of either the above type with efficiency and natural¬ 
ness and who voluntarily bear witness to the excellence of the 
manner in which they have been fitted out, and their increased 
capabilities to perform their full share of work. 



CHAPTER Yin 

THIGH OR FEMORAL STUMPS 


Definitions. —Thigh or femoral stumps are those that reach 
to any point above the knee joint; they are designated upper-, 
middle-, or lower-third thigh stumps, according to their lengths, 
in relation to the three divisions of the thigh. 

Long or Lower-Third Thigh Stumps. —When a stump reaches 
to a point in the region of the lower third, it is commonly termed 



Cut H 1. 



a long thigh stump, a few of which are illustrated in Cuts H 1 to 
H 4. 

Artificial legs suitable for such are illustrated in Cuts H 5 and 
H 6. 

In cases of long and flabby stumps the number G 7 leg, see page 
82, can be applied to advantage. 

Stumps out of Line. —Persons walking on crutches for a con¬ 
siderable length of time permit their stumps to incline forward. 
The flexors in the groin become contracted and the extensors yield 
to the influence, and the stump assuming the position, when hang¬ 
ing at ease, of that shown in Cut H 1, and occasionally that 

84 





A. A . Marks, Artificial Limbs, New York City. 


85 


shown in Cut H 3. This condition should not cause anxiety on 
the part of the wearer, as it can be controlled and corrected by a 
suitably attached artificial leg. 

Construction of Legs. —The thigh and leg sections of H 5 are 
constructed of wood of choice character. The socket is hollowed 



Cut H 3. Cut H 4. 


out to receive the stump properly, and to receive the weight of the 
wearer where it can be tolerated. 

The outside dimensions both above and below the knee are 
dressed down to the curves and dimensions of the natural leg as 
far as conditions will admit. The lower part excavated to mini¬ 
mize weight, both sections are covered with rawhide and enam¬ 
eled, the foot is of sponge rubber with spring mattress as hereto¬ 
fore described. The manner in which the knee joint is constructed 
is substantially the same as shown in Cut E 6, and described on 
page 74. 

Variety of Middle-Third Thigh Stumps. —Thigh amputations 
through or above the middle thirds produce stumps that admit of 
the simplest form of knee-joint mechanism, called the T joint, 
explained further on. 

Cuts H 7 to H 14 show thigh stumps of a variety of lengths 
with flaps and cicatrices of many characters. 

End and Non-End-Bearing. —As a rule thigh stumps are in¬ 
capable of taking weight on their extremities, and as there is but 
little advantage in putting pressure on that point, and as the risk 
of doing so is very great, we rarely consent to construct limbs 




86 


A. A. Marks, Artificial Limbs , New York City. 



Cut H 7. 


Cut II 8. 









A. A. Maries, Artificial Limbs, New York City. 


87 




in that way and only do so when we are positive that the ends of 
the stumps will not be injured. Cut H 15 shows the usual type 


Cut H 9. 


Cut II 10. 


of artificial leg for a thigh stump. The thigh and leg sections are 
made of tough, light, bass or willow wood, shaped to the size and 


Cut H 11. 


Cut H 12. 







88 A. A. Marks, Artificial Limbs, New York City. 


contours of the natural leg so far as conditions will permit. The 
thigh is excavated to receive the stump in the best way, permitting 
pressure only at admissable places. The end of the stump, together 
with a few inches of the thigh, are, as a rule, required to hang in 
space, all the weight being applied to the upper borders of the 
thigh socket and along the sides of the stump immediately adjacent 
to the body. When weight can be prudently applied to the end 
a cushion is provided for that purpose. The lower section of the 



Cut H 14. 


Cut H 13. 


leg is excavated to reduce weight. The whole is covered with 
rawhide and elegantly finished with a flesh-tinted enamel. 

A rubber foot with spring mattress as heretofore described, is 
properly attached at the ankle. Cut H 16 represents the rear 
view showing the knee mechanism with parts together, and Cut 
H 17 represents the working parts of the knee separated. Cut 
H 18 shows the T joint, the spring, and their connections; a is the 
T joint which is secured to the knee block located at the lower 
end of the stump socket. The two arms work in journals made in 
the leg section; bb are the cap screws that hold the T joint to its 
place; cc the caps; d the spring piston; e the spiral spring; f the 
cylinder; g spring coyer, and parts of the spring together; Hi rep¬ 
resent the steel screws used to hold the T joint firmly to thigh. 
The joint a has the shape of an inverted T, hence its name, T 
joint. It is made of gun metal forged from one piece, turned, 










A. A. Maries , Artificial Limbs , New Yorlc City. 


89 


drilled, and finished on the lathe. When the leg and thigh sections 
are placed together the arms of the T joint rest in boxes and are 
held by two hardwood caps, cc , which are secured by long steel 
screws, bb, which depend for their security on steel nuts, imbedded 
in the front part of the leg. 

Thorough Control.— The wearer has thorough command over 
this joint; the pressure of the caps on the joints can be regulated 




Cut H 16. 


by the screws, and thus any desired tension on the articulation 
be made. 

Knee Spring. —The small steel lever with ball on the end, pro¬ 
jecting from the back of the joint, operates in the cavity of the 
hardwood piston d; the piston is inserted in one end of the steel 
spring, e, which has its lower part encased with leather <7, and then 
placed in a drawn metal cylinder f. The lower convexed end of 
the cylinder is received on a bridge placed in the interior of the 
leg in the region of the calf. 




90 


A. A. Maries , Artificial Limbs , New York City. 


Helps Knee Motion When Walking. —The operation of the 
spring is twofold; it urges the lower leg*forward in walking, and 



Cut H 19. Cut H 20. Cut II 21. 

holds it at full flexion when sitting. This is done in the fol¬ 
lowing manner: When the leg is extended, the point at which the 


































91 


A. A. Marks, Artificial Limbs, New York City. 


spring pressure is applied is on the end of a steel lever projecting 
an inch back of the center of motion in the knee. This urges 
further extension, as shown in Cut H 19, the lever revolves with 
the joint; and when the leg is partly flexed, as shown in Cut H 20, 
it has been carried to a neutral point where the spring neither 
urges flexion nor extension; but when the knee is further flexed, 
as shown in Cut H 21, the lever has passed forward of the neutral 
line and the spring forces the ball upward, urging greater flexion; 
and when the flexion is at its limit the leg is kept in that position 
by the spring. Thus the objection to the usual spring knee articula¬ 
tion is removed, that of the tendency of the leg to fly out when the 
wearer is sitting and unguarded. 

Spring Strength Can be Regulated. —The power of the spring 
in the knee can be increased or diminished. If it is desired to 
increase it, a little packing can be tamped in the cylinder, or a 
longer spring can be substituted; and if it is desired to diminish 
it, a coil or two of the spring can be cut ofl or a shorter one sub¬ 
stituted. If the wearer does not want the spring he can take it 
out and discard it. When the leg is together and in working 
order, the knee movement is arrested by the striking of the vertical 
shaft of the T joint against a pad placed in the knee, which can be 
increased or diminished by the wearer, and the range of articulation 
in the knee made less or greater, as may be desired. 

The center of motion of this knee is placed considerably back 
of the center of gravity of the leg in order to secure the knee 
against treacherous bending. 

Knee Lock. —The knee lock is a device placed in the knees of 
artificial legs to keep them from flexing, or from flexing beyond 
a fixed limit. When the wearer wishes to sit the knee can readily 
be unlocked. It is not very often that knee locks are required, 
therefore they are only placed in artificial limbs when conditions 
demand. 

Cut II 22 shows an artificial leg with knee lock for thigh stump; 
a is a sliding bar that can be moved upwardly or downwardly. 
When down the leg is incapable of moving at the knee, or is 
permitted to move only through a limited angle, as shown in Cut 
H 23. When the sliding bar is pulled up, the lock is out of action, 
and the knee can be bent at right ankles as represented in Cut 
H 24. 

This device is found to be of value to those who have short, 
weak, or deflected stumps, and is also used to advantage by eques¬ 
trians. We have a patron, a baptist clergyman, who finds the 
knee lock indispensable when performing the rites of immersion; 
because of the buoyancy of the lower leg the knee without the 
lock would flex the moment he enters the baptismal font. Knee 
locks are used to advantage by persons who are required to walk 
through obstructions, such as underbrush, heavy grass, snow, etc.; 
without the locks these obstructions are likely to flex the knees 
inopportunely. Hip joints and waist belts are occasionally at¬ 
tached to the thighs of these legs. 



92 


A. A. Marks, Artificial Limbs , New York City. 


Hip Joints. —The knee lock, hip joint, and waist belt can be 
combined to advantage in legs applied to stumps that are deflected, 
abducted, or that in any way incline out of the normal lines. The 
knee lock places the knee beyond the influence of the partly flexed 
stump, and the hip joint places the leg bej^ond the influence of 



the abducted stump. As these auxiliary parts complicate the con¬ 
struction of the leg, add weight, and more or less hamper graceful 
and natural walking, it is not considered desirable to add them 
unless the conditions of the stump or the occupation of the wearer 
demand. 

Waterproof and Bathing Legs. —Persons wearing artificial 
legs on thigh stumps frequently find it desirable to use their arti¬ 
ficial legs while they are bathing or swimming in salt or fresh 
water. It is embarrassing to those who have but one leg to be 
viewed with curiosity while hopping or walking with crutches or 
hitching on hands and knees on the shore. This embarrassment 
often prevents them from indulging in the exhilarating and health¬ 
giving river, lake, or ocean bath. 

An artificial leg especially designed for swimming and bathing 
purposes is constructed practically the same as those heretofore 
described, differing only in the fact that they are absolutely water¬ 
proof, the knee to articulate or not, as the wearer may elect. As 
the wearing parts of waterproof legs are made of composition in¬ 
stead of steel, they are not as durable as those made for ordi¬ 
nary purposes; they are therefore only made when especially 
ordered. 

Legs Without Knee Joints. —We have on a number of occasions 
been required to construct artificial legs for thigh stumps without 





A. A. Maries, Artificial Limbs, New York City . 


93 


knee joints. Cut H 25 shows an artificial leg of this type. The 
entire structure, including the foot core, is carved from a single 
piece of wood, slightly curved at the knee so as to represent the 
natural leg when partly flexed, for better accommodation when 
sitting. The foot is of rubber with spring mattress as described. 
The leg is covered in the usual way and enameled or water¬ 
proofed if it is to be used in watery places. 

Peg Legs —Peg legs are occasionally used on thigh stumps. 
They are practically artificial legs without feet. As already stated 
we do not advocate the use of peg legs, as they are of limited effi¬ 



ciency. The foot is a very important part of an artificial leg. It 
assists in balancing, aids in walking, and restores the appearance. 

Years ago before artificial legs with rubber feet and spring 
mattress were so generally used, the peg leg was more in evidence, 
but lately it is worn more as a means of disciplining the stump or 
as a makeshift to bridge an impecunious period. 

Persons are able to stand, stump about, and perform a limited 
amount of labor on peg legs, which are unquestionably better than 





94 A. A. Marks , Artificial Limbs, New York City. 


crutches, but their restoration is not complete until they are 
wearing artificial legs with spring mattress rubber feet. Cut H 26 
shows a peg leg for a thigh stump. It is made of suitable wood, 
excavated to receive the stump and reduce weight. The outside 
has the contours of nature as closely as the conditions will admit, 
the end terminating in a metal ferrule and rubber tip, as illus¬ 
trated on page 71, Cuts E 57-58-59. Cut H 27 shows a peg leg 
with knee joint, for a thigh stump. It is constructed in all parts 
the same as H 15, heretofore described. The absence of the foot 
and the substitution of a rubber tip is the only difference. 

Suspenders. —Suspenders suitable for legs for thigh amputa¬ 
tions, as well as for amputations in the knee joint are of various 
kinds to suit the habits and demands of the wearers. The style 
of suspender which is most generally adopted is that illustrated 
in Cut H 28, termed the roller suspender. While it has excellent 



Cut H 28. 


Cut H 29. 


Cut H 30. 


features it has limited application. It can be used to advantage 
on stumps reaching to any point from the middle of the thigh 
to the knee, but for shorter stumps and for hip-joint amputations 
a method that will hold the limb to the body more firmly is neces¬ 
sary. The roller suspender is the product of many experiments 
and years of experience, assisted by the kindly suggestions of our 
patrons. 

The shoulder straps are usually of two-inch non-elastic webbing. 
A strip of webbing is attached to the right strap, and forms a loop 
through which the left strap passes. A piece of webbing stitched 
to the back of both straps holds them together. The front lower 
ends of the shoulder straps are received into buckles, and the 
back lower ends are terminated by snaps; each hooks into the ends 
of the leather roller cords which pass around rollers attached to 




















A. A. Marks , Artificial Limbs, New York City. 


95 


either side of the leg. Any degree of pressure upon the shoulders 
can be obtained by means of the clamp buckles, and when obtained, 
the buckles are clamped and are never disturbed, unless the pressure 
on the shoulders needs further adjustment. When it is desired 
to remove the limb, the suspenders are detached by unsnapping 
both front and back. 

Cut H. 29 shows a front view of a person wearing a pair of 
roller suspenders. 

# Cut H 30 gives the back view, and Cuts H 31, H 32, and H 33 
side views. 

These cuts show the relative positions of the rollers, as well as 
the effect of the loops in holding the shoulder straps in place and 



Cut H 31. Cut H 32. Cut H 33. 


in directing the leg. Elasticity is obtained by two pieces of 
elastic webbing attached to the backs of the shoulder straps a 
little below the shoulder blades. 

The operation of the suspenders is illustrated in Cuts H 29- 
30-31-32-33. All the traveling of the suspenders due to changes 
of position takes place about the rollers on the sides of the thigh, 
instead of on the shoulders of the wearer, whether the person is 
standing, stooping, walking, or sitting. 

Straight Shoulder Straps. —Cut H 34 shows a style of sus¬ 
pender especially adapted to an artificial leg for a short thigh 
stump. It is the style very generally used before roller suspenders 
were devised. The shoulder straps are of fine elastic webbing, 2 
inches wide. 

The front straps are of two-inch non-elastic webbing; each front 
strap passes through a metal link attached to the lower end of 
the elastic shoulder strap. After passing through the metal link 
the front straps are received into a two-prong buckle. The sus- 






96 


A. A. Marks, Artificial Limbs, New York City. 


penders are attached to the leg by means of leather tags and metal 
D’s screwed to the back and front. The metal D admits of side 
motion, thereby insuring direct pull. 

Belt Attachment. —Cut H 35 represents a belt and suspender 
combined. The shoulder straps and belt are preferably of non¬ 
elastic webbing. The straps running from the belt to the leg are 




Cut H 36. 


made of elastic webbing, 2 inches wide or less, as the case may 
demand. 

Vest Method. —Cut H 36 illustrates the vest method. It is made 
of strong muslin, fitted to the person and worn under the shirt. 
Elastic straps are attached to the lower border and buckled into 
straps that are secured to the leg. In order to obtain the best 
results, the vest must be made and fitted by a tailor. Persons who 
desire to have their artificial limbs constructed from measure¬ 
ments, and choose the vest suspender, are required to have vests 
made at home, and if sent to us, we will attach the straps and 
make the proper connections with the leg without additional charge. 

Suspenders for Women. —For obvious reasons the means of sus¬ 
pending artificial limbs to women differ from those employed with 
men. When shoulder straps are used they must pass over the 
shoulders and not press upon the breasts. Yokes, girths, or bands 
must pass around the waists so as to place the burden all or in 
part on the hips. 

Yoke Method. —Cut H 37 shows a combination of the roller 
straps with the yoke; rollers or pulleys are secured to the sides of 
the thigh, and leather cords pass around them. The yoke is made 











































A. A. Maries, Artificial Limbs, New York City. 


9 1 


to fit the loins and hips, adjustable by lacing in front or on the 
sides, as may be preferred; the shoulder and roller straps are also 




Cut H 37. Cut H 38. 

adjustable, so as to bring the proportionate weight about the 
shoulders and hips without displacing the yoke. 

Corset Method. —As many women pride themselves on their trim 
waists and neat-fitting garments, it is especially desirable that 
means of leg suspension should be light and neat. Straps securely 
sewed to the corset, extending downward and connected with the 
artificial limb, admit of the neatest adjustment. Cut H 38 shows 
the corset method, which can be easily adjusted by the wearer* 


























CHAPTER IX 

HIP-JOINT AMPUTATIONS 

Requirement. —An amputation at the hip joint or close to 
the body requires an artificial leg identical in construction to 
either of the patterns heretofore described for thigh stumps, with 
the exception that some modifications are introduced in the knee 
and the means of suspension is more complex. 

Muscle Stump. —Cuts 1-1 and 1-2 illustrate front and side 
views of amputations at the coxo-femoral or hip articulation, 
leaving a stump composed entirely of muscle tissue. A muscle 




Cut 1-3. 


stump is capable of performing some functions, although limited, 
in the management of an artificial leg, and may be considered as 
more desirable than no stump at all. Cuts 1-3 and 1-4 represent a 
liip-joint amputation in which there is no protruding stump by 
which the artificial leg can be directed. The amputated surface at 
the base of the pelvis is capable of bearing pressure. 

Leg Applied. —Cuts 1-5 and 1-6 show a leg applied to hip-joint 
amputation having muscle stump. The means by which it is 
suspended consist of a waist belt, shoulder strap, over each 
shoulder, flexion and extension elastic straps, a metal hip joint 














A. A. Marls, Artificial Limbs, New Yorh City. 


99 



Cut 1-7, Cut 1-8. Cut 1-9, 


t /yA. MARKS, M.X. 























100 A. A. Maries , Artificial Limbs , New York City. 


substituting the natural hip articulation, and an attachment by 
which the knee can be locked and made immovable, or capable of 
having but limited motion, these features have all been explained 
in the preceding chapter. 

The hip joint is important as it keeps the artificial leg directly 
under the wearer. The waist belt with its elastic straps front and 
rear assists in flexing and extending the leg at the hip. The leg 
is held firmly to the body when standing or walking; it should 
be especially noted, that it is not advisable to allow any knee 
motion while the wearer is learning to control the leg. During 
this period the knee motion is only for sitting convenience. 

Cut 1-7 shows a leg with pelvic socket suitable for a hip-joint 



amputation where there is no protruding stump to control the 
artificial hip motion. 

Cuts 1-8, 1-9, 1-10, 1-11, 1-12, show the leg applied and the 
wearer in many positions. The pelvic socket takes in a part of 
the pelvis and holds the artificial leg firmly to its place no mat¬ 
ter what positions the wearer may assume. The hip joint is 
controlled by throwing the body forward or backward of the cen¬ 
ter of gravity of the leg. 

Artificial legs for hip-joint amputations support the amputated 
side in a very comfortable and natural manner. The leg, having 
little or no stump to control it, is thrown forward by means of a 
side motion of the body. Persons with reasonable perseverance 
soon learn to control legs under these conditions in an advan¬ 
tageous way. 










CHAPTER X 

BOTH-LEG AMPUTATIONS 

The triumphs of artificial limb-making are shown to advantage 
in the restoration to active life of those who have had both of 
their lower extremities removed. When such persons are enabled 
to get about freely, walk gracefully, and engage in such labors as 
their callings in life require, a great and beneficial work has been 
accomplished, and the strongest possible evidence is presented to 
show that the mind of the prothesist has not been passive during 



Cut J 1. Cut J 2. 


the past half century. The problems these cases present are pro¬ 
foundly difficult, thought and effort have never been given to more 
laudable purposes than to their solution. The amelioration of the 
conditions of these unfortunate persons commands the highest tal¬ 
ent and the most humane impulses. 

Ancient Methods. —But a short time ago the loss of both legs 
was regarded as irreparable. The person who met with that mis¬ 
fortune was either consigned to a wheel chair, or obliged to hitch 
himself about on his knees or haunches. Cuts J 1 to J 4 show 
some of the various methods employed by those deprived of both 
their limbs. Formerly these methods were the only means for 

101 


102 A. A. Marks , Artificial Limbs, New York'City. 


locomotion tlie subject could employ. But at tbe present time 
the methods are used preliminary to obtaining and wearing arti- 




Cut J 5. 



Cut J 6. 


ficial legs. When these methods are contrasted with those that 
are shown later on, the progress and developments that have been 
made in the adaptation of artificial legs will be in plain view. 
Both Feet Partly Amputated. —Out J 5 shows a case in which 


































A. A. Maries, Artificial Limbs, New York City. 


103 


both feet were removed at the insteps; a pair of artificial legs 
constructed on the plan of Cut C 18, page 32, was applied. 

Lower Instep and Leg Amputations. —Cut J 6 shows an ampu¬ 
tation of the left foot at the instep and of the right leg at the 
junction of the lower and middle third. Artificial legs C 18 and 
E 17 were applied. 

Both Feet Amputated at the Ankles. —Cut J 7 shows a 
double ankle-joint amputation with the extremities incapable of 



Cut J 7. Cut J 8. 


bearing pressure. A pair of artificial legs, constructed on the 
plan of D 21 and described on page 43, was applied. Cut J 8 
shows the same case with the legs applied and the wearer stand¬ 
ing. In this particular instance the amputations resulted fjom 
frostbite, and the extremities of the stumps were very sensitive 
and with impaired circulation. It was therefore necessary to 
avoid interference with circulation and to secure the absolute 
freedom of the extremities from contact. 

Ankle Joint and Knee Amputations. —Cut J 9 shows an am¬ 
putation of the left foot at the ankle after the Pirogoff method, 
and the right leg at the knee joint after the Gritti operation; 











kfcJWARKS, N.Y. 


104 A. A. Marks, Artificial Limbs, New York City. 



Cut J 9. 



Cut J 10. 



Cut J 11. Cut J 12. 


artificial legs D 12 and G 17 were applied. Cut J 10 presents 
the wearer with artificial legs applied and attired as in daily life. 
Upper Instep and Leg Amputations. —Cut J 11 shows an am- 


























A. A. Marks, Artificial Limbs, New York City. 


105 


putation of left foot at the* instep and the right leg at the middle 
third. Artificial legs C 18 and E 17 were applied. Cut J 12 




Cut J 14. 



Cut J 16. 


shows the wearer with the legs applied, engaging in his occupa¬ 
tion as oysterman. This person has been employed in that indus¬ 
try for many years, and finds himself unhampered in his work. 










106 


A. A. Marks, Artificial Limbs, New York City. 


Cut J 13 shows an amputation of the right foot at the instep 
and of the left leg immediately below the knee. The right foot 
was poorly nourished, and sensitive at the extremity, so much 
so as to completely prohibit any pressure. Cut J 14 illustrates 
the same case with D 21 and E 17 legs applied. 

Both-Leg Amputations. —Cuts J 15 to J 21 illustrate amputa¬ 


tions of both legs at various points between the knees and ankles, 
covering many lengths, characteristics of flaps, and situations of 



cicatrices. Artificial legs suitable for any of these amputations, 
as shown in Cut J 21, are constructed on the plan of E 17. Cut 
J 22 shows the legs applied. The freedom with which wearers 
of legs for double amputations can get about, the naturalness 
with which they can sit, lie down, stand, walk, ascend elevations, 
ladders, ride bicycles, skate, and engage in almost any occupation 
are shown in Cuts J 22 to J 32. 

Practical Results. —Persons wearing two artificial legs are 
so thoroughly in control of their means of locomotion that they 
go about much as other people. They readily resume their former 
occupations, no matter how arduous they may have been. Cut 
J 28 illustrates a case of double-leg amputations with artificial 
legs E 17 applied. A short time after obtaining the legs the 
wearer resumed his work of baggage master, lifting heavy trunks, 
carrying them about, and putting them on trains as one would 











A. A. Marks, Artificial Limbs, New York City. 


107 



Cut J 19. 


Cut J 20 



Cut J 21. 


Cut J 22. 


A. A. MARKS, N.VJ 





















108 A . A. Maries , Artificial Limbs, New York City . 


do with natural legs. Cut J 29 portrays a railroad man with two 
artificial legs operating a switch. He dismounts, attends to the 



switch, frequently gets aboard while the train is in motion, a-nd 
performs the work of a brakeman. He moves about quickly, steps 
over ties, and appears to be on as firm footing as if he had never 



Cut J 24. Cut J 25. 


been deprived of nature’s extremities. Cut J 30 shows a young 
man wearing two artificial legs, plan E 17; he is a conductor on 
a railroad, performing his duties in a thoroughly efficient manner. 








A. A. Marks , Artificial Limbs, New York City. 


109 


He walks through the train when it is running at its greatest 
speed, collects tickets, and punches them. The cars jolt, pitch, 



Cut J 26. Cut J 27. 


and sway, but he retains his balance with no perceptible effort 
or awkwardness. 

At stations he alights, watches passengers, gives signals, and 
boards his train. It never occurs to anyone that his lower ex- 



Cut J 28. 


Cut J 29. 


tremities are not real, and his actions never betray that fact. 
With wooden articulating feet it would be extremely difficult for 






























































A. X. MARKS, N. V. 


110 A. A. Maries , Artificial Limbs, New York City. 



As A. MARKS, HJt 



































A. A. Marks , Artificial Limbs , New York City. 


Ill 


him to discharge such duties. He would feel unsafe, tottlish, 
and unsteady, but with rubber feet with spring mattress, rigidly 
attached, he has sound footing, and is capable of the most difficult 
feats of balancing. 

Below-Knee and Knee-Joint Amputations. —Cut J 31 rep¬ 
resents a case with both legs amputated; the right disjointed at 
the knee, and the left amputated three inches below the knee; 
Nos. E 17 and G 7 legs were applied. This man when in street 



Cut J 33. 



Cut J 34. 


attire presents the appearance of a person with natural extremi¬ 
ties. He walks naturally, and never consents to use a cane. 
He is a member of the Knights of Pythias, and takes pride in 
parading with his lodge. Cut J 32 shows him in his uniform. 

Below-Knee and Above-Knee Amputations. —Cut J 33 repre¬ 
sents amputations of both legs, the right below the knee and the 
left above the knee. Cut J 34 represents the same case, with 
E 17 and H 15 legs applied. 

Cut J 35 shows a similar case; the right stump only five 
and one-half inches from the body, and the left one and one-half 
inches below the knee. E 17 was applied to the left side and 
H 15 to the right. The subject was restored to not only a natural 
appearance, but to the ability of walking without the aid of 













112 A. A. Maries, Artificial Limbs , New Yorlc City. 


canes or crutches, and so naturally that he has associated with 
persons for long periods without betraying the fact that his lower 
limbs were artificial. This young man has walked half a mile 



Cut J 35. Cut J 36. 


in eight minutes without great effort. He works at the bench 
during the day, and the evenings are frequently spent at the 
billiard table. Cut J 36 shows him as he appears on his artificial 
legs, and in street attire. 

Engaging in Former Pursuits. —We have many patrons wearing 
E 17 and H 15 artificial legs for double amputations who exhibit 
remarkable skill in performing feats that require sound footing. 

Cut J 37 shows a person with two artificial legs as above de¬ 
scribed in a rowboat, illustrating the manner in which he can 
brace himself while pulling a strong oar. 

Cut J 38 shows another similarly equipped at the pool table, 
balancing himself on one foot while making a difficult shot. 

Cut J 39 represents another with thigh and leg amputation, on 
a ladder, at a great distance from the ground; his footing is 
sound, his arms are free; he can hold a paint can in one hand, 
while he applies a brush with the other. 

Cut J 40 represents another riding horseback, securely seated 
in the saddle, and feet in stirrups. The spring mattress rubber 












A. A. Marks y Artificial Limbs , New York City. 113 


feet are used in all of these cases, and sound and reliable footing 
are due to the excellent feature obtained by that means. 

Both Legs and Both Arms Amputated. —Cut J 41 represents 
a case in which both legs and both hands were amputated. A 



Cut J 37. 


pair of artificial legs, and a pair of artificial arms were applied. 
The wearer became able to walk about in a very natural way; 
his artificial arms enabled him to feed himself at the table, write, 



and perform such work as does not depend upon delicate finger 
movements and the sense of touch. 

Both Legs Amputated Above the Knees. —No matter how ex¬ 
tensively a person may be dismembered, prothetic science is ea- 



























114 A. A. Marks, Artificial Limbs , New York City. 


pable of rescuing him from a life of helplessness. Only a brief 
period has elapsed since it was considered rash to apply a pair 
of artificial legs to a person who had both of his natural legs 
amputated above the knees. Attempts to substitute such a large 
portion of the body depending on short thigh stumps for support, 
resulted in failures, and until modern ideas were introduced and 
appropriate means for attachments were devised, failure followed 



every effort. In 1864 the first pair of artificial legs was applied 
to double thigh amputations; the subject was a soldier of the 
Civil War. Although he was able to sit, stand, and walk on his 
artificial legs, the effort was so great that the wearer soon tired 
of them and abandoned their use, and became the occupant of 
a wheel-chair, dependent on his family. 

In 1879 Mr. Marks made his second attempt, and succeeded ad¬ 
mirably. The subject was a young man with two thigh stumps 
that reached nearly to the knees. This man soon acquired the 
art of balancing, and became so adept that he could walk about 
the house without the aid of canes or crutches, but when in the 
street he found it necessary to use a pair of canes. He has worn 
the pair of legs made in 1879 up to the present time. He is 
engaged in active business pursuits, and has reared and supported 
a large family. 

Since the above date we have applied upwards of a hundred 
pairs of artificial legs to double thigh amputations. The manner 


















































A. A. Marks, Artificial Limbs , New York City. 


115 




in which these limbs were constructed, the way in which they were 
applied and adjusted, and the methods employed to give better 
control of the movements have varied according to the conditions 























116 A. A. Marks, Artificial Limbs, New York City. 


of each case. Each double thigh amputation presents problems 
of an individual character, and as there are seldom two alike, 



Cut J 45. Cut J 46. Cut J 47. 


these problems must be solved by the manufacturer. The solu¬ 
tion lies in the hanging of the legs, the method of suspension, 



Cut J 48. Cut J 49. 

limiting the motion of the knees, and the absolute rigidity of the 
ankles. We cite a few cases* 



























A. A. Maries , Artificial Liiribs, New York City. 117 


Cut J 42 represents double thigh stumps, produced by ampu¬ 
tations made to remove deformed parts. A pair of artificial legs 
A suitable construction was applied. The great lengths of these 
stumps gave such control over the artificial limbs that it was not 
necessary to apply hip joints or knee locks. The subject was a 
musician. In a brief time he was able to walk naturally, resum¬ 
ing his profession, and now has a national reputation as a clari- 
onetist. He walks on the stage, plays the instrument, acknowl¬ 
edges encores, and retires in the usual stage manner. 

Cut J 43 represents a double knee joint amputation. A pair 
of suitable artificial legs are shown in the same cut. Cut J 44 



Cut J 50. Cut J 51 - 


shows the artificial legs applied, and the wearer in the act of 
walking. 

Cut J 45 represents a child who had both legs amputated above 
the knees on account of a railroad accident. A pair of artificial 
legs with knee locks was applied to advantage. The child has, 
for a number of years, walked on the artificial legs very satis¬ 
factorily. He has been enabled to walk to school and indulge in 
childish pastimes. The manner in which the artificial legs were 
held in place is shown in Cut J 46, front view, and Cut J 47, 
rear view. 








118 A. A. Marks, Artificial Limbs , New York City. 


Cut J 48 represents a double thigh amputation, the result of a 
railroad accident. Cut J 49 shows the application of a pair of 
artificial legs with the wearer seated. Cut J 50 represents the 
same person standing, and in Cut J 51 he is attired as he ap¬ 
pears when walking. This case is one of the most remarkable on 
record. The stumps only extended to about the middle of the 
thighs, but through the energy of the wearer and the efficiency 
of the artificial legs, he was able, in a brief time, to walk about 
in a very natural way, and go up and down stairs; he uses no 
canes about the house. The artificial legs H 15 were applied with 
hip joints and automatic knee locks, but after a brief time the 
wearer dispensed with the locks and found that he could control 
the artificial knee joints without danger of treacherous flexing. 
Under earlier systems this case would have been considered hope¬ 
less, and the thought of applying artificial limbs would never 
have been entertained. 



CHAPTER XI 


ARTIFICIAL FEET AND LEGS FOR DEFORMITIES, 
PARALYSIS, EXCISIONS, ARRESTED GROWTH, 
SHORTENED LEGS, ETC. 

Deformities of the feet or legs may be due to causes congenital, 
traumatic, or pathological. Appliances for such cases frequently 
partake of the character of artificial legs and call for the skill 
of the prothetician. 

No matter how greatly distorted, deformed, or weakened one or 
both legs may be, there is reasonable hope that some appliance 
can be used that will aid locomotion, hide the affected parts, and 
restore a fair degree of symmetry to the person. 

Short Leg. —The most frequent leg abnormity is that of short¬ 
ening, due to hip-joint troubles in infancy, or to paralysis. 



Cut K 3. 


Cut K 2, 


Cut K 1 


Cut K 1 represents a case of shortened leg caused by hip dislo¬ 
cation. The front of the foot is dropped downwardly to enable 
the subject to walk on the ball of his foot. 

Talipes-equinus. —Cut K 2 represents a case of talipes-equmus, 
leg shortened from one to three or more inches, due to paralysis. 
The ankle joints in K 1 and K 2 were normally strong and the 
knees and hips under thorough control. Cut K 3 shows an appli¬ 
ance suitable for either of the above cases. It is termed an 
extension foot, and is constructed from a wooden block, the upper 
surface shaped to receive the sole of the affected foot, with the 
front part dropped to a convenient angle (see dotted line). I he 


119 











120 A. A. Marks, Artificial Limbs, New York City. 


under surface of the block is connected with the lower part of 
a rubber foot. The entire structure is covered with suitable 
leather, the upper of which runs well up on the leg, incasing 
the entire foot and ankle. Cut K 4 is a shoe, to be drawn over 
the foot and appliance. It is usually a part of the mate of the 



Cut K 4. 



Cut K 5. 



shoe worn on the opposite foot, the quarter having been removed 
and a larger one put on having the shape and dimensions required 
to fit properly. This alteration in the shoe is easily made, and 
can be done by any shoemaker at slight expense. The extension, 
when complete and covered by a shoe, is shown in cut K 5. Cut 
K 6 shows it covered with the trousers. Persons with these appli¬ 
ances walk much better than they do with the old style, thick 
sole and high-heel shoe. They present a better appearance and 
are far more comfortable. 

Talipes with Lateral Weakness. —Cut K 7 represents a short¬ 
ened leg with talipes and loss of control over the ankle joint, there 
being a strong tendency for the ankle to give way sidewise. A 
suitable appliance is shown in the same cut. It is constructed 
of wood, carved from a block with naturally curved grains, or 
made of aluminum, as conditions require. It receives the leg and 
foot in a comfortable way and holds them firmly in place. The 
heel and toes are of rubber. Cut K 8 represents the case with 
appliance in place and wearer walking. In cases of atrophy of the 
calf, which frequently accompanies these cases, the leg structure 
can be carved to approximate the contours and dimensions of 
the sound leg. There will scarcely be an appreciable increase in 
weight. 

Toe Support. —An appliance of above type is helpful in holding 
the foot in correct position, and on account of the rigidity of 
the ankle the wearer obtains toe support that enables him to rise 
on the ball of the foot when walking. This produces a natural 





A. A. Marks , Artificial Limbs, New York City. 121 


step, avoids limping, and enables the wearer to go np and down 
stairs and alight on elevations. It also aids him in balancing, 
and, as the point of resistance at the ball of the foot is in advance 
of the knee joint, the tendency of the knee to flex is counter¬ 
acted; this adds materially to the efficiency of the apparatus, 
giving the wearer a feeling of confidence and security. A person 



with a paralyzed leg, using ordinary braces, usually finds it neces¬ 
sary to press his hand against his knee joint when his weight 
is on the affected leg. He does this to keep the knee from flexing 
and precipitating a fall, but with the appliance just described 
firmness of the knee joint is obtained by phalangeal support m 
the foot, and the wearer is not dependent on pressure placed m 
his knee joint, or on attachments going above the knee. 

Cut K 9 shows a shortened leg with hip and knee joints under 
control; the ankle suffered a loss of strength and required sup¬ 
porting. ... ,, . 

Cut K 10 represents a leg shortened by hip-joint trouble m 
youth, producing a deficiency in length of about ten inches; the 
knee and hip joints are under control and the bottom of the toot 
is capable of bearing weight. Cut K 11 represents a leg, designe 
for each of the above cases, the natural foot is dropped to the 
greatest angle that can be tolerated and made to rest on an 











122 


A. A. Maries, Artificial Limbs, New York City. 

- , 

inclined surface at the required distance from the floor. The leg 
is incased by a socket made of wood and leather. Cut K 12 



represents the appliance in place, and Cut K 13 shows the patient 
properly and neatly attired. 

Congenital Deformity.— Cuts K 14 and 15 illustrate the front 
and side views of a case of congenital deformity. The foot 



Cut K 12. Cut K 18. 

appears to be attached to the external side of the tibia immedi¬ 
ately under the fibula. Weight can be borne on the sole only 
when the foot is held in position. Cut K 16 gives a side view of 





















A. A. Maries, Artificial Limbs, New York City. 


123 


a suitable appliance constructed substantially the same as K 11. 
The displaced foot is held firmly in correct position and the 
wearer walks helpfully and quite naturally. 

Talipes-varus.— Cut K 17 represents a case of talipes varus, 
resulting from paralysis—the knee joint being involved. A suit- 



Cut K 14. 



Cut K 15. 



Cut K 16. 


able appliance is shown in the same cut. Cut K 18 shows appli¬ 
ance in place and the wearer seated; with this appliance the 
wearer is enabled to walk acceptably. 

Leg Deformities. —Cut K 19 represents a deformed right leg. 
From the knee down, the leg is diminutive, terminating in a 



miniature foot, inclined inwardly and backwardly; the shortening 
due to arrested development amounts to eight inches. Cut K 20 
shows a suitable leg. The deformed leg, from the knee down, is 
















124 A. A. Maries , Artificial Limbs, New York City. 


received into the socket of the artificial leg and held there com¬ 
fortably. A rubber foot, with spring mattress placed at the 
required distance to restore length, fully equipped the child with 
means of locomotion. 




Cut K 21. Cut K 22. Cut K 23. 

Cut K 21 represents a right-leg deformity; hip, thigh, and knee 
under normal conditions; the leg from the knee down undevel¬ 
oped, foot very small, terminating in a great toe growing from 


Cut K 19. 

































A. A. Maries, Artificial Limbs, New York City. 125 


the internal side. Cut K 22 shows an artificial leg devised for 
the case. The deformed leg is received in the socket and laced. 
Ihe toe is provided with a protecting pocket, the weight is taken 
partly on the plantar surface of the miniature foot and partly 
about the leg below the knee and about the thigh. When first 
applied the leg only reached to the knee, but it was found that 
there was a weakness in the knee, with a tendency to abduct; knee 
joints and thigh support were added, which prevented yielding to 
lateral weakness. Cut K 23 shows the leg applied and the child 
standing. Since the application of the appliance the child has 



Cut K 24. Cut K 25. 



Cut K 26. 


Cut K 27. 


grown rapidly in stature and weight, well developed, strong and 

healthy. . . _ 

Cut K 24 represents a congenital deformity of the right leg, 
consisting of a malformed foot, miniature leg, and abnormal rela¬ 
tions of tibia and fibula. The tibia extends to the ankle, without 
connecting with the foot. The fibula connects with the foot but 
not with the leg, the two bones held in position by cartilage. 
When standing on the right foot the bones would slide by each 
other over an inch; there was also lateral weakness, rendering 
walking impossible without assistance. Cut lx 25 represents an 
appliance constructed for the case, made of aluminum formed 
to receive the foot and leg in a comfortable way, terminating with 
a rubber foot. The weight, when standing or walking, was 
placed on the internal sloping surface of the tibia, immediately 
below the knee. The socket held the tibia and fibula in position. 
This appliance has been used for many years, enabling the 
wearer to engage in arduous labors, and capable of walking great 
distances without fatigue. 

Cut K 26 represents a shortened and malformed leg. The 
shortening appears to have been located wholly in the leg between 












126 A. A. Marks, Artificial Limbs , New York City . 


the knee and ankle. Cut K 27 represents a suitable leg. It is 
constructed to receive and hold the deformed member firmly in 
place. A rubber foot, placed under the foot-rest, gives the 
required length. The motion in the ankle made it possible to 
drop the toe to a concealable angle. Although the apparatus had 
the appearance of a double foot, there was no difficulty in con¬ 
cealing the deformity by the trousers. 

Cut K 28 illustrates a deformity of the right leg. The hip and 
thigh are normal and an undersized foot appears to have grown 



Cut K 28. Cut K 29. Cut K 30. Cut K 31. 


immediately from the knee. The patient was able to flex and 
extend the foot the same as a leg, or, in other words, he had an 
articulation at the junction of the thigh and the foot, the tibial 
section being absent. Cut K 29 represents an artificial leg devised 
for the case. It is similar in its general construction to that 
represented in Cut E 17. The socket of the leg is excavated to 
receive the foot, the knee joints and thigh supporter give the foot 
control over the artificial part. 

Cut K 30 represents a deformed left leg. From the knee down 
it was misshapen, contracted, and distorted. Cut K 31 represents 
a suitable artificial leg applied. The deformed parts were placed 
well up and out of the way, concealed by the dress. 

Cut K 32 represents a deformed lower right leg, very similar to 
the one just described. The knee, however, admitted of more 
flexion, and the artificial leg was made to receive the thigh and 
deformed part in one s©cket and was held in place by means of a 
leather sheath passing from the rear and lacing to the front line 
of the thigh, as shown in Cut K 33. 

Infantile Paralysis.— Cut K 34 represents an undeveloped left 










A. A. Marks , Artificial Limbs , New York City. 12T 


leg, the entire limb considerably atrophied and the joints weak, 
caused by infantile paralysis. Cut K 35 represents an artificial 
leg especially designed for the case. The deformed leg is received 
in the socket and laced in place and the foot dropped to the 
greatest angle of toleration. The thigh piece incases the thigh 



Cut K 32. Cut K 33. Cut K 34. 


and the joints support the knee; a rubber foot is placed at the 
extremity. Cut K 36 presents a side view of a similar appliance 
with a knee lock, which is necessary in cases of loss of control 

in the joints. , . , 

Cut K 37 represents a deformity of the right leg; the hip, thigh, 
and knee normal and healthy, but the leg and foot diminutive in. 
size, with foot rotated outwardly. Cut K 38 represents an arti¬ 
ficial limb especially devised for the case. The undeveloped leg 
is received into the socket, the foot protrudes through an aperture 
on the external side, the knee joints and thigh piece placed above 
the knee, give support and strength about the thigh. A rubber 
foot, with spring mattress at the lower extremity, completes the 
apparatus and gives the required support. 

Obstructed Growth. —Cuts K 39 and K 40 represent cases of 
obstructed growth, the hip joints normal, the thighs possessing 
nearly the proper lengths, terminating in short and misshapen 
legs. Cut K 41 represents a leg suitable for either case. Both 
these persons were enabled to walk nearly as well as if normal 
conditions existed. A slight enlargement of the trousers a little 
above the knee (necessary to accommodate the deformed leg) is 
the only noticeable difference in the two sides, and that differ¬ 
ence so slight as to be observed only by the critical eye. 










128 A. A. Marks, Artificial Limbs, New York City. 



Cut K 35. Cut K 36. Cut K 37. Cut K 38. 



Cut K 42 represents a deformity consisting of an undeveloped 
femur and partially developed leg, the knee joint located very 




























A. A. Marks, Artificial Limbs, New York City. 


129 


close to the hip. A suitable artificial leg is shown in same cut. 
The wearer walks so perfectly with this leg that his deformity is 
absolutely concealed. 

Both Legs Deformed.— Cut K 43 represents a deformity, both 
legs atrophied, talipes-varus, feet abnormally large. Ampu¬ 
tation of both feet at the ankle joint after the Symes method 
was advised. This was done and the patient obtained a pair of 
legs, on which he walks and performs labor acceptably. Cuts 
K 44 and K 45 represent front and side views of a deformity of 



Cut K 42. 




Cut K 43. 


both feet. From the hips to a little below the calves normal 
conditions were present; at about the calves there were false joints 
supplementary to the knee and ankle articulations. These false 
joints were under poor control, not sufficient to hold the feet in 
proper position. We advised the amputation of both limbs 
through the false joints. This was done, and the child had two 
excellent tibial stumps on which artificial legs, style E 17, were 
applied and worn with comfort and efficiency. 

Cut K 46 represents a case of amputation of right leg and 
talipes-varus in the left. A suitable artificial leg for the right 
side and a helpful appliance for the left are shown in the same cut; 
Cut K 47 shows the limbs applied and the wearer standing erect. 
The disposition of the leg to rotate inwardly was controlled 










130 A. A. Maries, Artificial Limbs, New York City . 


by the appliance and the leg was compelled to operate in the line 
of progress. 

Cuts K 48 and K 49 represent front and side views of a case 



Cut K 44. 



Cut K 45. 


of congenital deformity of both legs, rendering walking very diffi¬ 
cult and more largely dependent upon crutches than on feet. We 
advised the amputation of both legs at the calves. The subject 



Cut K 46. Cut K 47. 


submitted to the amputation of the right leg, but decided to retain 
his left, which appeared to have more sustaining power. Cut K 
50 represents the case after the amputation of the right leg, and 




















A. A. Maries, Artificial Limbs, New York City. 


131 


Cut K 51 represents him with the artificial leg applied, while Cut 
K 52 shows him dressed. The condition of the wearer was greatly 
improved by the removal of the right leg and the application of 



an artificial one. The improvement would have been carried 
further if he had submitted to a similar operation on the left 
side, thereby obviating the outward curve of the lower leg, which 



Cut K 50. Cut K 51. Cut K 52. 

is conspicuous even when covered with trousers. Cut Iv 53 rep - 
resents a case of paralysis of the right leg, knee slightly flexed. 
Cut K 54 represents the same with one of our instruments 

















132 A. A. Marks , Artificial Limbs, New York City. 


applied; wearer seated. It was constructed with knee joint, pro¬ 
vided with automatic lock, preventing flexing with the weight 
directly over the leg, permitting flexion when the wearer is seated. 
The foot is held in proper position for standing and prevented 
from flexing treacherously when walking. 

Cut K 55 represents congenital deformities of both legs; 
branches grew from the inner surfaces of both femurs. That on 
the right thigh was ten inches in length, on the left not more than 
two. The knee joints were on the inner surfaces of the ends of 



Cut K 53. Cut K 54. 


the femurs, feet everted and badly formed. In boyhood, loco¬ 
motion was obtained by moving about on his haunches; later he 
walked with the aid of crutches, bearing on the ends of his femurs 
and dragging the deformed legs. For twenty-five years he sub¬ 
mitted to these awkward and unsightly means for getting about. 
His attention was finally called to artificial limbs, and upon con¬ 
sulting well-informed persons he found that he could improve his 
condition by having the useless parts of the legs removed and 
artificial ones applied. We indicated points at which amputa¬ 
tions could be performed to advantage. After the operations his 
stumps presented the appearances shown in Cut K 56. We 
applied a pair of artificial legs, constructed on the plan of those 
represented in Cut G 8. When dressed, this man had the appear- 








A. A. Maries , Artificial Limbs , New York City. 


ance of a person with natural and well-formed legs. Cut K 57 
is taken from a photograph, showing him as he appears in ordi¬ 
nary life. 

Cut K 58 represents a case of arrested development. The child 
was well formed from the knees up, but from the knees down his 
deformity was pronounced and of a character to render walking 



Cut K 55. 


Cut K 56. 


Cut K 57. 


impossible. The child managed to get about rather awkwardly 
with crutches, permitting but little weight to come on his fee . 
As the joints in the ankles and knees were flexible, and as the leet 
were small, we found that we could incase the entire legs, provide 
knee motion, and place rubber feet at suitable distances below 
the deformed ones. This was done, and the lad was brought to 
his proper height, making a presentable appearance and walking 
in a very acceptable way, without the aid of crutches. He con¬ 
trolled the artificial knee joints by means of his feet and had 
little or no difficulty in balancing, walking, sitting, rising, ascend¬ 
ing or descending steps. Attention was given to ornamentation, 
and when dressed his deformity was entirely concealed, as shown 
in Cut K 59. 






















134 A. A. Maries, Artificial Limbs , New York City . 


Drop Foot. —The drop foot, resulting from paralysis or arrested 
development, is a frequent infirmity. Usually the leg is of normal 
length, the knee joints contracted and weak, with loss of control 
at the ankles and lateral weakness or a tendency for the foot to 
bend sidewise, either varus or valgus. The only practical manner 
in which a leg of this sort can be rendered useful is by fixing 
the ankle joint artificially, thus providing a resistance at the ball 
of the foot, the concomitant for balancing, maintaining height 
when walking and serving as a lever for propulsion, and as a 
counteracting influence to the tendency of the knee to flex. Cut 
K 60 represents a case of this kind. Cut K 61 represents the 



appliance we have devised for such. It is practically a form of 
splint, cast of aluminum to the shape of the leg and foot. The 
metal is carried under the entire foot, holding it at a proper angle 
for walking. The front is provided with leather, arranged for 
lacing. This appliance holds the ankle joint fir ml y and provides 
support at the ball of the foot, which is so far in advance of the 
center of motion of the knee that it prevents the knee from flexing 
when the weight of the wearer is directly over the foot. Persons 
with these appliances walk rapidly and quite naturally, seldom 
requiring any attachments above the knees. 

In connection with appliances of this type for paralyzed lower 
extremities we may quote from the Cincinnati Lancet-Clinic of 
October 9, 1897. A prominent physician read a paper before 
the academy regarding the treatment of his own paralyzed leg: 

u An illustrated catalogue fell into my hands, in which was 
pictured, among artificial legs, etc., an apparatus made of alumi¬ 
num, splint-like in character, with a rubber cushion under the 
foot to compensate for shortening. It was made for a case of 
congenital dislocation of the ankle. The more I studied it, the 







A. A. Marks , Artificial Limbs , New York City. 


135 


more it appealed to me that such an apparatus could be made for 
my own comfort. I had reached a period when I was considering 
amputation and the substitution of an artificial leg for my para¬ 
lyzed one. Impressed with the illustration of this apparatus, I 
consulted a friend upon the subject. He was as much impressed 
with it as I was, but advised me to obtain the opinion of our 
surgical friends. They were likewise impressed with it and 
advised that I try the conservative measure first before I resort 
to the radical one. I went to New York and consulted the 
maker. After studying my deformity for a few minutes, he stated 
that an apparatus could be constructed that would materially 
improve my condition. The appliance was made and worn for 
four years. But those four years! How can I describe them? 
Pen and words fail me. It was like a beautiful oasis in a dreary 
desert of years of suffering. In connection with my deformity 
there was a weakness of the abductor muscles, which permits of 
a rotation outwardly of the thigh. This has been overcome by 
rubber abductor muscles. The one fastened to the outer side of 
the apparatus crossed the front part of the right thigh, crossing 
to the left side of the trunk, and is inserted into the harness. 
The one attached to the inner side of apparatus is inserted over 
the right posterior part of the harness, which is suspended from 
the left shoulder. 

“Who are my benefactors? Who are those who have given to 
me the comfort of four years’ duration, with a bright future of 
many more? And, within such a short period, free from pain, 
caused the twenty odd years of suffering to disappear in the dim 
and misty past? 

“ Oh, for a trumpet of such power to herald to the world their 
name, that those who are needy may seek them! But instead, in 
gratitude do I raise my feeble voice and wish the cup brimful of 
happiness for the firm of A. A. Marks, New York City. 

“ ‘ By thy deeds shalt thou be known! ’ ” 

Knee Joints Locked. —Shortened and paralyzed legs are fre¬ 
quently accompanied with total loss of the power of extension and 
flexion in the knee joints. In such cases the mechanism of the 
artificial knee joints is provided with locks that hold the knees 
rigid when standing or walking. The joints are capable of being 
unlocked to admit of flexion when sitting. 

Cut K 62 represents a shortened, atrophied, paralyzed leg. Cuts 
K 63 and K 64 show the same case, with apparatus in place. The 
apparatus consists of a socket that incases the leg, knee joints 
with locks that support the knee, thigh piece that takes the sup¬ 
port about the thigh, and a rubber foot placed under the deformed 
natural foot in order to obtain the proper length. 

Limited Knee Motions. —Cut K 65 represents a shortened leg 
with limited motion in the knee, the knee capable of flexion, but 
incapable of extension beyond the angle represented in the cut; the 
hip normal and the bottom of the foot capable of enduring pressure. 
Cut K 66 represents an artificial leg suitable for the case. It is 



136 A. A. Marks , Artificial Limbs, New York City. 


made with a wooden socket, fitted to receive the leg. A comfortable 
shelf is provided for the foot to rest upon. Knee joints with pawl and 



rack and thigh piece incasing the thigh are provided. The pawls 
at the knee joints are operated by levers which pass up the rear of 



Cut K 65. Cut K 66. Cut K 67. 


the thigh. When standing or walking, the leg is brought to the 
point of greatest extension, the pawls automatically drop into the 
rack and make the leg immovable at the knee. The moment the 

















A. A. Marks , Artificial Limbs , New York City. 


137 


wearer is seated, the lever will rest on the chair and force the 
pawls out of their racks, allowing the knee to flex (see Cut K 67). 
By this means the wearer is able to walk safely with rigid knee 




and bend the knee when sitting. The apparatus has a rubber foot 
with spring mattress placed at the proper distance below the 
paralyzed one. 

Ununited Fractures. —Cut K 68 represents an ununited fracture 
of the tibia and fibula at a point a little above the ankle joint. 
Usually, in cases of this kind, it is deemed advisable to amputate, 
the wisdom of which we do not question. Occasionally, however, 
and particularly in the case here illustrated, the horror of the knife 
kept the patient from submitting to that alternative, and he came 
to us for help with a dangling foot, under no control whatever. He 
was young and in good health, and cherished the hope that if the 
fractured parts were held firmly in juxtaposition, nature might 
eventually, in her mysterious way, bring about a union. We 
constructed an aluminum socket, incasing the leg from the knee 
down and the entire foot, fixing the ankle. This appliance, shown 
in Cut K 69, was fitted when the tibia and fibula were in apposi¬ 
tion. Weight was communicated from the bottom of the appli¬ 
ance to the leg immediately below the knee. Ho weight what¬ 
ever was brought on the foot and no strains permitted to cause 
the bones to move out of the places in which they were held. The 
appliance has been worn advantageously for a number of years. 
The manner in which the wearer gets about, walks, and attends 
to his vocation is exceedingly gratifying. 

Cut K 70 represents an ununited fracture of the right tibia, due 
to gunshot wound. All efforts to bring about a union failed. The 
fibula was not injured, but in consequence of failure of union i.n 








138 A. A. Marks , Artificial Limbs, New York City. 


the tibia it was obliged to do the work of both bones. Being 
overtaxed, it gradually yielded and became curved, as shown in 
the cut. The dark spot immediately below the patella represents 
a deeply indented scar at the point of fracture. Cut K 71 repre- 




Cut K 72. 


sents a suitable brace for the case, made of wood and leather. A 
block of wood is excavated to receive the fractured member in its 
most comfortable position. The leg, when placed in this splint¬ 
like appliance, is held firmly by means of lacing. As the injury 
shortened the leg about one inch, a block of suitable thickness 
was hinged to the lower extremity of the splint on which the 
foot rested. Owing to the proximity of the fracture to the knee 
articulation, it was impossible to construct the brace that would 
admit of knee motion. The appliance has done its work for a 
great many years with great satisfaction to the wearer. 

Fractured Knee Caps, etc. —Resections of knee joints, frac¬ 
tures of knee caps, weakening of the patella ligaments, in fact any 
ailment that lessens or destroys control over the knee articulation 
is greatly benefited by appliances similar to that represented in 
Cut K 72. The socket below the joint is made of wood, with a 
leather front capable of being laced. The upper socket is made 
entirely of leather. The knee joints are made with stops, so that 
extension cannot be made beyond the proper limit. In cases of 
partly flexed knees, due to knee-joint disease, this appliance can 
be used to advantage, requiring knee locks in addition. 





CHAPTER XII 

FACTS FOE CONSIDEKATION 

Wooden Feet Substituted by Rubber Ones. —Artificial legs, 
manufactured with wooden articulating feet, are more or less 
troublesome and expensive to keep in order, and are deficient in 
supplying the requisite propulsive power in walking, it is there¬ 
fore often deemed advisable to remove them and substitute rubber 
ones. We have devised methods by which this can be done, 
whether the legs be constructed of wood, leather, or metal. Our 
charge is $20.00 in each case. We guarantee the attachment to 
be strong and lasting. A foot of any size or shape to meet the 
wishes of the wearer can be put on, and the leg can be made 
longer or shorter, as may be desired. 

A Way to Test the Rubber Foot. —The attachment of a rubber 
foot to an old artificial leg is often done to test its merits. It 
gives an admirable opportunity for the wearer to try the rubber 
foot and ascertain for himself the advantages it has over those he 
has worn. 

An experiment of this sort can only be successful when the 
socket of the old artificial leg fits correctly; if it does not, the 
leg cannot be worn comfortably and satisfactorily, no matter what 
kind of a foot it may have. 

A cabinet maker, carpenter, or other mechanic, be his skill in 
his own line what it may, should not be expected to connect a 
rubber foot to an artificial leg with assurance of satisfactory 
results. The alignment, the set of the foot, the angle at which it 
should be placed relative to the shaft, are important factors and 
must be thoroughly understood and their relations to each other 
comprehended, or the results will be disappointing. This knowl¬ 
edge can only come from experience; we therefore dissuade per¬ 
sons from buying rubber feet and having them put on their arti¬ 
ficial legs by home mechanics. We therefore insist that artificial 
legs be sent to us for such work, and for which we make no extra 
charge. 

Ease and comfort in wearing an artificial leg depend almost 
entirely upon the manner in which the socket receives the stump. 
No matter how correctly the leg maj be constructed, or with what 
nicety the parts operate, it is worthless if it causes pain, abrades 
the stump, or interferes with the circulation. 

Fitting—an Art. —The fitting of an artificial leg is an art, only 
acquired by thought and the experience of years. A thorough 
knowledge of the anatomy of the stump, the effects of pressure 

139 


!40 A. A. Marks, Artificial Limbs , New York City . 


m various points, the manner in which interference with the cir¬ 
culation or the displacement of tissues on the stump can be 
obviated must be understood, or the fitter is not qualified to be 
intrusted with such work. 

There are a great many artificial limb manufacturers in the 
world, but there are a very few fitters. 

Only One Way to Fit. —There is but one way in which a leg 
can be made to fit correctly, and that is to excavate a block of 
wood until it has the proper size and shape to receive the stump, 
so that pressure will be placed where it can be endured, there 
must be absolute freedom from contact on the blood vessels and 
exposed nerve areas. 

A leg that puts pressure uniformly on the stump is not a com¬ 
fortable one to wear, for there are many places on every stump 
that cannot bear any pressure whatever. There are other places 
that can endure any amount of pressure; a socket to be comfort¬ 
able must, therefore, be made so as to apply pressure only where 
it can be endured. 

When Plaster Casts are Useless. —A plaster cast of a stump 
and a plaster cast of the inside of a socket that fits the stump 
correctly are no more alike than the last on which the shoe is 
built is like the foot on which the shoe is worn. It is absurd to 
assume that a serviceable, comfortable socket can be made by 
molding a plastic material, such as leather, felt, or wax, on the 
cast of a stump or by molding it on the stump itself. Sockets 
so made are always irritating and cause pain and suffering. It 
is likewise an error to assume that a block of wood can be cut 
out to the contours of a plaster cast of a stump and fit the stump 
comfortably. If it were so, the fitting of an artificial leg would 
be reduced to a mechanical operation which could be conducted by 
inexperienced and inexpensive persons. If the work could be 
done in this way, the cost of an artificial leg might be considerably 
lessened. 

Machine Fitting a Failure. —The irregular form turning lathe, 
with which all mechanics are familiar, carves a stick of wood 
to the exact shape of the model. Axe handles, gun stocks, 
shoe lasts, and many other articles are made in this way. A 
machine of this kind has been modified so as to excavate a block 
of wood so it will have the exact shape of a plaster mold of a 
stump. A socket for an artificial leg made in this way must be 
greatly modified by hand before it can be worn with comfort. 

When we are reminded that the stump is bone covered with 
muscles, fat, blood vessels, nerves, tendons, and skin; that these 
coverings are not of uniform thickness: that they are soft, yield¬ 
ing, and easily displaced: that more pressure can be applied on the 
least sensitive parts, and that where the nerves and blood vessels 
are the most numerous less pressure can be endured, we will readily 
see that a socket, to fit properly and not injure the stump, must 
be fitted by persons skilled in the work, who know the location of 
the large blood vessels, the character and disposition of the nerves. 



A. A. Maries , Artificial Limbs, New York City. 


141 


and who are keenly alive to the necessity of avoiding pressure on 
the vascular parts. The skilled fitter does not always need the 
presence of the person who is to wear the leg he is fitting. Cir- 
cumferences and diagrams of the stump will guide him in doing 
more accurate work than is possible for an incompetent fitter, 
though he be supplied with plaster casts, or fits directly to the 

stump. . ,. 

When Casts are Necessary. —Plaster casts are desirable in 
some cases. They convey contours, locate irregularities, promi¬ 
nences, and tender spots on abnormal stumps, or on those that 
reach to the knees, ankle joints or insteps, and in such cases are 
quite necessary, but, generally speaking, stumps that extend to 
any point between the articulations do not require to be repro¬ 
duced in plaster. 

Wood Sockets the Best. —The advantages of wood sockets are 
many Wood is light and firm, retaining the shape it receives 
from the skillful fitter. No matter what conditions may exist—the 
tender spots of a stump are always protected, weight is applied 
where it can be endured, and when the socket is highly polished 
there is absolutely no friction. A stump may move, slip, and 
slide without becoming blistered or abraded. 

Weight.— The weight of an artificial leg varies from one to 
seven pounds, according to its size and the severity of the labor 
it is to perform. We have made artificial legs that weighed less 
than a pound for infants, and we have been obliged to make 
them seven or eight pounds in weight in order to be strong enough 
for active, three-hundred-pound persons. The only way to obtain 
strength is by the employment and proper disposition of suitable 
material. A small leg is not as heavy as a large one, and a strong 
leg must be heavier than a frail one. 

Rubber Boot not Heavy.—A leg with a rubber foot can be 
made from six to sixteen ounces lighter than the ordinary arti¬ 
ficial leg with articulating ankle. The lessening of weight is 
chiefly caused by the absence of the metallic ankle connection. 

The notions of those wearing artificial legs are varied, there¬ 
fore they cannot be used as guides. One man says, make my leg 
as light as you can, even at the sacrifice of strength; I would 
rather have a light leg and renew it more frequently than to carry 
a heavy one. Another will say, do not make my leg too light; I 
have worn light and heavy ones, and I find that I can walk more 
steadily and step more naturally with a leg of moderate weight. 
The leg should act as a pendulum; the moment it is lifted from 
the ground it should swing forward of its own weight and not 
depend upon energy imparted by the stump. Still another will 
say I do not care what the leg weighs so long as it is made 
strong: strength is the desideratum. If it weighs a pound or 
two more I will not object to it, as I can soon get used to that, 
but it must be strong and last a long time. I cannot afford to 
take chances on the leg breaking.. The utmost diversity of 
opinion, therefore, exists on this subject. 



142 A. A. Marks, Artificial Limbs, New York City. 


The greatest demand, however, is for the lightest leg, consistent 
with strength. 

For light, delicate women, weighing less than a hundred pounds, 
a full-length leg weighing three pounds without attachments is as 
light as it is prudent to produce. So light a leg with ample sus¬ 
taining strength is almost a marvel. We know of nothing calcu¬ 
lated to withstand equivalent strains that weighs so little. A 
leg weighing six pounds for a large, heavy person, who is likely 
to subject it to severe use, is not excessive, and should not be 
objected to. 

Let us think, for a moment, of the weight of other instruments 
that are made to stand similar strains. The weight of the bicy¬ 
cle has been reduced from sixty to nineteen pounds, and it is 
generally conceded that a nineteen-pound bicycle is as light as 
prudence will allow. Persons marvel at a bicycle weighing so 
little, yet the nineteen-pound bicycle has no more work to perform 
and is not subjected to any more strains than an artificial leg 
weighing from three to six pounds. The bicycle, like the leg, 
has only to support the weight of the rider and resist such strains 
as may occasionally be brought upon it. 

In constructing a leg it is essential to make it strong enough 
to sustain the weight of the wearer and not break under such 
sudden strains as it is likely to receive at times. If one slips 
and recovers himself with his artificial leg, some part receives a 
strain that is much greater than the weight of the wearer. In 
ascending or descending stairs the strains on the leg are greater 
than in walking. A leg should be made strong enough to meet 
these demands, and, in addition, must have a margin of strength 
that will enable the wearer to carry such articles and lift such 
weights as his vocation requires. No matter how crippled one may 
be, or what his station in life is, nor how delicate, there will be 
times when he will thoughtlessly lift, carry, push, or pull some 
weighty object. Should the leg break under any of these condi¬ 
tions, the maker would unquestionably be severely censured. 

It is not wise to build an artificial leg so close to the danger 
line, especially for delicate persons, that when those persons 
become healthier, stronger, and heavier the leg will break. Condi¬ 
tions do not remain the same. “The weak of to-day are the 
strong of to-morrow.” The light person frequently becomes heavy, 
and the careful limb maker, if he guards his reputation, will keep 
well on the side of safety. 

The average weight of a substantial artificial leg, suitable for 
a thigh amputation, worn by a man weighing one hundred and 
fifty pounds, engaged in an ordinary occupation, may be placed 
at five pounds, less for a below-knee or foot amputation. 

It is possible to localize the weight of a leg weighing six 
pounds so that it will feel lighter than one weighing half as 
much, improperly adjusted. Inadequate means of attaching the 
leg to the body will make it feel heavy. A heavy lower part, 
with a light thigh piece, produces an apparently heavy leg, because 



A. A. Maries, Artificial Limbs, New Fork City . 143 


the weight is distant from the stump and the frail thigh piece 
does not hold it in place securely. On the other hand, a strong, 
substantial thigh piece, which properly holds the leg in place, will 
lessen the apparent weight considerably. 

Odor. —The contention that rubber emits a disagreeable odor is 
untrue. Sponge rubber has no more odor than wood; moreover, 
the rubber foot is incased with an air-tight material. Even if the 
rubber had a disagreeable odor—which it has not—it would not 
be possible for it to escape. On the other hand, the ankle joints 
of articulating feet have to be oiled very frequently, and the oil 
in time becomes rancid. No refined person can possibly tolerate 
such an odor. 

Temperature. —The rubber foot will not alter its consistency 
on account of changes in temperature. Properly vulcanized 
rubber, such as is used in the manufacture of our rubber feet, 
will not lose its elasticity in any temperature the human body is 
capable of enduring. It requires 280 degrees of heat (Fahrenheit) 
to produce a change in rubber, and as there is no habitable place 
on the earth with a temperature half of that, the rubber foot is 
never in danger from heat; no human being could live in a tem¬ 
perature intense enough to harden pure rubber. 

The Mass of Limb Wearers are of Small Means— The greater 
number of wearers of artificial limbs are in limited circumstances. 
It is exceptional to find a wealthy person in need of one. The 
wage-earner, the laborer, the man who works in the mill, the engi¬ 
neer, fireman, brakeman, or the miner, the private in the army, those 
whose occupations place them in jeopardy and who are exposed 
to the dangers that destroy life or mutilate the body, these make 
the greatest number of limb wearers. This being so, it is the more 
important that artificial limbs should be durable and as inexpen¬ 
sive to wear as possible. The first cost, the purchase of the limb, 
should be the only important item to be provided for. An arti¬ 
ficial leg constructed with delicate machinery, or parts subject to 
friction, may be attractive to look at, but is ill-suited to the 
wants of the man who has to support himself and his family by 
daily toil. The loss of time in having repairs made, the cost of 
repairs, and the danger of breaking down at critical times, are 
serious’ matters, and the careful man will take them into con¬ 
sideration before making his selection. 

We do not know an artificial leg with an ankle joint that is now 
made, that has ever been made, or, perhaps, ever will be made, 
that will not cost from five to twenty-five dollars a year to keep 
in repair. The delicacy with which an ankle joint must be con¬ 
structed in order to be light and small enough for its narrow 
limits, and the immense strain that it must resist at times, are 
conditions incompatible with durable mechanism. 

The fact that persons walk, run, and perform all kinds of labor 
on artificial legs with rubber feet without ankle motion is evi¬ 
dence that the ankle mechanism is unnecessary. Men, women, 
and children with rubber feet run, walk, skate, and dance* Work, 



144 


A. A. Marks, Artificial Limbs, New York City. 


regarded not many years ago as impossible, is now being daily 
performed with facility. The farmer follows bis plow on a 
rubber foot, the blacksmith works at his forge, the sailor climbs 
his rigging, the builder erects houses, and persons of every voca¬ 
tion attend to their affairs with as little concern and hindrance, 
operating on one or a pair of our rubber feet, accomplishing as 
much as their associates who are in possession of all their natural 
limbs. 

How Long Will a Leg Last? —The question is frequently 
asked, “ How long will an artificial leg last ? ” There is but one 
reply: it depends upon the care the leg receives. We have patrons 
who are still wearing artificial legs that were made for them 
twenty-five years ago, and the legs still appear to be in fair con¬ 
dition. These are exceptional cases and should not be referred 
to, any more than should the experiences of those who, through 
abuse and carelessness, destroy their artificial limbs in an unex¬ 
pectedly short time. An average made of the frequency with 
which our patrons renew their substitutes, fixes the period at 
about eight years. This does not imply that a leg will not last 
longer. Necessity by no means occasions all renewals; wearers 
want new legs much the same as they want new coats, before the 
old ones are completely gone. Wearers become as proud of their 
artificial limbs as they do of articles of apparel; those financially 
able frequently supply themselves with several, so as to have a 
reserve for emergencies. Accidents are as likely to occur to the 
substitute as to the real ones. Men have been run over by vehicles 
and have had their artificial legs crushed instead of their natural 
ones. When accidents of this kind occur, the limbs must be sent 
to the manufacturer for repairs. The wearer who is fortunate 
enough to have a duplicate which he can put on is at a great 
advantage. Taking all these facts into consideration, and fixing 
the average life of an artificial leg at eight years is certainly 
estimating on a fair basis. 

Shoes and Stockings. —All artificial feet should be dressed with 
stockings and shoes, as are natural ones. The wear and tear on 
shoes and stockings, when the feet articulate at the ankles, are 
enormous and have been a source of complaint. This annoyance 
is removed by the use of rubber feet, for shoes on rubber feet look 
and wear like those worn on the natural, as the wrinkling at the 
toes and other parts is nearly identical in both. We have heard 
patrons say that in five years their rubber feet have saved 
them in the cost of stockings and shoes enough to buy a new 
leg. 

How Soon after Amputation Should an Artificial Leg be 
Applied?—A s soon as the stump is thoroughly healed and the 
patient has regained sufficient strength to go about on crutches, it 
is time for him to consider the matter of procuring an artificial 
leg. Before procuring one some attention should be given to the 
preparation of the stump. 

Treatment of Stumps. —Tight bandages should be worn is on? 



A. A. Marks , Artificial Limbs, New York City. 145 


the moment the stump is healed until the artificial leg is applied. 
Bandages are inexpensive and can be frequently renewed. The 
stump corset suggested by some is made as follows. A block of 
wood is carved to the shape and dimensions of the stump; a 
piece of substantial leather is moulded upon this form, the edges 
running down the front are permitted to remain apart about 
two inches, eyelets are put on each edge to admit of lacing, straps 
to hold it in place are attached as shown in the cuts. A shoe¬ 
maker or saddler within the reach of the wearer can usually be 
found who will make the corset at little expense. No matter how 
soft and pliable the corset is made, it has not the adjustability of 
ordinary bandages, therefore its use is not encouraged. 



Cut L 1. Cut L 2. 


Cut L 1 represents one with suitable straps for leg amputation 
and Cut L 2 represents one for a thigh stump. 

The knee and hip joints should be moved very frequently, and 
the stump rubbed vigorously in order to maintain mobility. 

No matter what means are employed to reduce a stump before 
an artificial leg is applied, it is doubtful if all the changes can 
be brought about. As a rule stumps become smaller from wearing 
artificial legs. The pressure received from the socket has a tend¬ 
ency to force absorption and solidify the tissues. The extent of 
this emaciation cannot be conjectured. Some stumps do not 
change even when artificial legs are worn for years. On the 
other hand, we know many cases where the stumps have grown 
larger. The matter is governed by the disposition of the wearer, 
his occupation and his activities. 

If a stump reduces after an artificial leg is worn, some compen¬ 
sative adjustment must be employed, lining the socket with thick 
material as leather, felt, or cloth, or by wearing a number of socks 
on the stump, one drawn over the other is the most convenient 
way, but in case of great shrinkage, so much so that such fillings 
are objectionable, it will be necessary to remove the socket from 
the leg and substitute a new and smaller one. We do this work 






146 A. A. Marks , Artificial Limbs, New York City. 


for our customers at small expense, but new measurements and 
diagrams are required and the entire leg must be sent to us. 

If the stump is one that will-yield to pressure it will not only 
become smaller under the influence of the bandage or corset, but 
must grow still less by the use of the artificial leg. Under such 
circumstances, it is an important economical question to deter¬ 
mine whether it may not be wiser to immediately apply a leg and 
change the socket, should it become necessary, than waste time 
in bandages or shrinking corsets. 

The Gain in Applying a Leg Immediately. —The immediate 
use of an artificial leg enables the wearer to dispense with 
crutches at the earliest possible moment, to gain the freedom of 
his arms, attend to his vocation, and take healthy and vigorous 
exercise. The cost of a new socket to fit a reduced stump is in¬ 
significant when the advantages of wearing an artificial leg dur¬ 
ing the interval the stump is changing are taken into account. 

Walking on crutches is dangerous, a slip or fall may seriously 
injure a stump. An artificial leg is the best protective device for 
the stump. 

The single exception to the wisdom of early applications is in 
amputations which result from malignant diseases. 

Dangers in Delay. —If a stump is permitted to go for six 
months without performing its share of work, it will become weak, 
nervous, and disordered, and circulation will become sluggish. It 
is much more difficult to use an artificial leg on a stump that has 
been permitted to get into this condition than if applied imme¬ 
diately after it has healed. 

We have applied artificial legs within a month after amputa¬ 
tion with good results, although this time is exceptionally brief. 
It is impossible to indicate the exact length of time that should 
elapse between the amputation and the application; it is safe, 
however, to say that a limb can be judiciously applied as soon 
as the wound is healed, even if there be tenderness on the ampu¬ 
tated surface. It is well to remember, in this connection, that 
with rare exceptions the end of the stump bears no pressure what¬ 
ever. 

It is a common error to assume that a stump will become hard 
and tough in time. Nothing can harden or toughen it except 
use, and there is no better way to toughen a stump than to use 
a leg. The hands of a laborer are strong and hard because he 
uses them in performing his work. Those of a person not accus¬ 
tomed to manual labor are soft, tender, and delicate, and become 
easily blistered because they have not been disciplined. Exactly 
the same principle is applicable to stumps. 

Surgeons are at variance in their views on this topic. Some 
advise an early application, others insist on their patients waiting 
an unreasonable length of time. The surgeon who has studied the 
subject in all its bearings invariably agrees with the advice given 
above. 

Cork Legs. —The term il cork leg ” has long and frequently been 




A. A. Marks, Artificial Limbs, New York City. 147 


used to designate an artificial leg. The prevailing impression is 
that there is or has been an artificial leg made principally of 
cork. This is an error and should be corrected. Cork is known 
to every mechanic as a very friable substance, on account of 
which it has not strength enough to form any part of the support¬ 
ing structure of an artificial leg. 

The origin of the term “ cork leg ” is not known. It has, how¬ 
ever, been said by credible authority, that the term originated 
from the fact that years ago very good artificial legs were made 
in Cork, Ireland, which were called Cork legs, the same as legs 
made in London are called London legs, those made in New York 
are called New York legs, etc. 

There have been many doggerels written in which the word cork 
is used to designate an artificial leg. 

Thomas Hood, in his Golden Legend, “Miss Kilmansegg and 
Her Precious Leg,” speaks of cork and wooden legs, neither of 
which was good enough for the fastidious Countess: 

« She couldn't, she shouldn't, she wouldn't have wood, 

Nor a leg of cork if she never stood! 

And she swore an oath, or something as good. 

The proxy leg should be golden! ” 

It is evident that at the time the above was written, many years 
ago, the term “ cork leg ” was misunderstood the same as it is now 



CHAPTER XIII 

ARTIFICIAL LEGS FOR THE AGED 

To be deprived of a natural leg after having passed the allotted 
span of life is indeed a calamity, and the thought of wearing an 
artificial one is entertained with forebodings. Will not the in¬ 
firmities of age come fast and heavy? Has not the shock sapped 
the vital reserve so that early decline will make the purchase an 
unprofitable one? Is the prospect of living a few years promising 
enough to justify the attempt? These are questions of gravity 
that come with force especially to those in moderate circumstances. 

As is shown in another part of this book, the loss of a leg, no 
matter how old or enfeebled the patient may be, instead of hasten¬ 
ing the fatal day, has a tendency to give a new lease of life. The 
removal of a diseased leg serves as a tonic to the entire system. 
If the finger of death has been laid upon the foot, as in senile 
gangrene, remove the foot and the decay will cease. 

Like cutting the dying limbs from an old tree, the vital forces 
will be more generously distributed among the remaining parts 
and the tree will take on new life. 

It is no greater task to learn to walk on an artificial leg than 
to learn to use crutches, and as a matter of fact an artificial leg 
is much safer. To put an aged person in a rolling chair and de¬ 
prive him of the health-giving walks is to invite disaster. The 
aged as well as young will rust out sooner than they will wear out. 

Age must not be taken into consideration; as soon as the stump 
is healed an artificial leg should be obtained; in a very brief 
time the wearer will be able to get about without depending upon 
others. Walks in the open air and healthful exercise will be in¬ 
dulged in, and gratifying results will follow. 

A few cases bearing on this matter may be cited: 

The Rev. Edward Beecher, of Brooklyn, N. Y., brother of the 
famous Henry Ward Beecher, lost a leg by accident in his eighty- 
fourth year. For several years prior to that time there were evi¬ 
dences of senility, and when he met with his accident it was not 
supposed he had vitality enough to survive it. Amputation, how¬ 
ever, was proceeded with. Mr. Beecher recovered from the shock, 
and in a very short time was convalescent. He was soon able to 
take short walks on crutches, but the fear of falling made the task 
difficult and exhausting. 

The writer well remembers when he was summoned to this dis¬ 
tinguished clergyman’s house. He was seated in a chair, looking 
very tired. He had just returned from a walk on crutches. 
u l am a very old man,” he said, “ and I do not think I have long 

148 


A. A. Maries , Artificial Limbs , New York City. 


149 


to live. The idea of buying an artificial leg appears to me a 
piece of folly; but my friend, Mr. Sage, is insistent that I 
should get one and try it. Whether I succeed or not, it will make 
no difference to you, but considerable with me. If I ever learn 
to walk on the leg I know I shall feel better, and I am going to 

try.” 

The leg was made and applied, and in a very brief time he 
acquired the art of walking on an artificial leg. He moved cau¬ 
tiously at first, but soon got so that he could put entire confidence 
in the limb. He took long walks daily, and attended to his 
church and parish work with renewed vigor. The leg was much 
easier for him to walk on than crutches, and gave him a feeling 
of security. He wore it for eight years, when he died at the age 
of ninety-two. Is it reasonable to assume that, if Mr. Beecher had 
not applied an artificial leg, but had resigned himself to the cot 
or rolling chair, he would have lived to that ripe age? Did not 
the walking that he was able to do, and the open air exercise, con¬ 
tribute to his health, and add to his life? The denial of an arti¬ 
ficial leg would certainly have been a severe punishment to this 
good man for having lost his leg in old age. 

Charles Van Brunt, of Long Branch, N. J., had his foot ampu¬ 
tated on account of senile gangrene when he was seventy years 
old. An artificial leg was applied as soon after the amputation 
as prudence admitted, and he lived for fifteen years and wore the 
leg constantly. He died at the age of eighty-six. During much 
of the time he performed the duties of school janitor. 

George Hinman, New Haven, Conn., had his leg amputated 
when he was eighty years old. He obtained an artificial one and 
wore it continuously for four years, during which he was active 
on his feet and walked long distances. 

Mrs. Susanna Brown had her leg amputated above the knee when 
she was seventy-three years of age, a result of an accident. An 
artificial leg was applied four months after the amputation. She 
wore it three years and was active in domestic work. Dr. A. L. 
Britten, of Athens, Ill., writes about this case as follows: 

“ Mrs. Susanna Brown, of Cantrall, Ill., for whom you manufac¬ 
tured an artificial leg after she had passed her seventy-third birth¬ 
day, found it eminently satisfactory. She was helpless in no 
sense. She could, and did, ascend and descend stairs without 
assistance, and without fear of falling.” 

David Penfield lost his leg on account of gangrene when he 
was seventy-two years of age. Dr. White, of Franklin, N. Y., in 
one of the letters says of the case: “ The facts in regard to 
David Penfield are briefly told as follows: He was in the seventies 
when I first saw him, and had had two attacks of cerebral apoplexy, 
which left one arm and one leg paralyzed to such an extent as to 
make walking and use of arm impossible. Gangrene presented 
itself and I amputated the foot of the affected leg. He recovered, 
and I obtained an artificial leg from you for him. He very soon 
learned to use it, and was able to walk about fully as well as before 



150 A. A. Marks , Artificial Limbs, New York City. 


his trouble. He lived a considerable time after he obtained the leg, 
and found it a source of great comfort. His family and I regard 
the wearing of the limb as having added to his comfort and 
health.” 

Nelson Stevenson, Salem, Ind., had his leg amputated above the 
knee when sixty-seven years of age. An artificial leg was applied 
a few months later, which he wore for over three years. 

Frederick Triebold, St. Paul, Minn., had his leg amputated 
above the knee when seventy-four years of age (in 1894). An 
artificial leg was applied eight months after the amputation 
which he is still wearing (1905). Hr. A. H. Steen, in writing 
of the case, says, “ Frederick Triebold considers the artificial leg 
made for him indispensable, his health is good, and he wears the 
leg at all times.” 

Russell Perkins lost his leg in 1894, when he was sixty-nine 
years of age. An artificial leg was applied within eight months. 
Hr. William R. Lough, of Edmeston, N. Y., says, “ Mr. Perkins 
gets along well with his artificial leg. He does his chores around 
the farm, and frequently comes to town. He does not use a cane 
and gets along very well.” 

James R. Bugbee lost a leg when he was seventy-six years of 
age on account of a fall. He had an artificial leg applied, 
which he is still wearing with great comfort. In one of his let¬ 
ters he says, “ I am now seventy-nine years old. I am able to do 
my work around the house and garden, which I positively could 
not do with crutches.” 

William P. Hiller, of Nantucket, Mass., lost a leg in the Civil 
War. He is still living, and has worn an artificial leg continu¬ 
ously since. He is now eighty-two years of age. 

Mr. Bradford Beal had his leg amputated in 1894 at the age 
of eighty-three. The leg was applied the following February, 
and he wore it with comfort and relief for over five years. We 
quote from a letter: “I am wearing the artificial leg constantly. 
I go about the house without cane or crutch. I have walked a 
mile from home and back a number of times without fatigue.” 

Equally encouraging reports can be given of hundreds of similar 
cases. 



CHAPTER XIV 

ARTIFICIAL LEGS FOR INFANTS AND CHILDREN 

The Problem Considered. —It is a serious problem that con¬ 
fronts the parents of a child who has had one or both legs ampu¬ 
tated. The parent, in happy possession of all his limbs, realizes 
more keenly than the child the misfortune that has happened. 
An artificial leg is, no doubt, the immediate and only remedy 
that can be suggested, but even this presents thoughts of expense 
for remodeling, and the question is often asked if the benefits will 
justify the costs incurred, and whether it may not be better to 
wait until the child has obtained his growth, before equipping 
him with the needed limbs. 

A child, however young, is as greatly disabled by the loss of 
a leg as an adult. If one leg is lost he becomes dependent on 
crutches; if both legs are lost, he has to be carried in the arms 
or pushed about in a rolling chair, or is obliged to hitch himself 
about on his haunches as best he may. Such methods are at once 
unnatural and objectionable; they have a hurtful effect on the 
physique of a growing child, as well as harming the limbs, stumps, 
and joints. Walking on a pair of crutches for any length of 
time pushes the shoulders forward, settles the neck in the chest, 
and the spine fails to develop the _ sustaining strength demanded 
in later life. 

Walking on one crutch, as most children do, cants the body side- 
wise, elevates one shoulder above the other, tilts the pelvis, and 
produces an over-development of one side of the body at the ex¬ 
pense of the other. If the use of crutches is continued through¬ 
out the growing period, the disproportions resulting from unequal 
development will bring troubles that will last through life and 
imperil health. The stump, being pendent from the body and 
performing no functions, will become poorly adapted to the use 
of an artificial leg. The muscles will become atrophied, the 
joints enervated, and the range of motion lessened. It will be 
troublesome to wear an artificial leg under these conditions, and 
the task of disciplining the stump will be more difficult. It is 
doubtful if the harm thus done can ever be righted. 

Wo can cite many cases where the neglect to apply an artifical 
leg to a growing child has been the cause of physical weaknesses 
that have been impossible to correct. Contracted hips and knees, 
weakened spines, deflected and rotated stumps, are a few of the 
many ills that have been traced to this neglect. 

Failure to apply artificial legs in double amputations is 

151 


152 A. A. Marks , Artificial Limbs , New York City. 


attended with more serious consequences. The stumps are held 
in flexed positions and subjected to such unnatural influences 
that the wearing of a pair of artificial legs, when undertaken 
later on, is greatly hampered. The art of balancing is forgotten 
and has to be learned again. The hip joints, having been in 
flexed positions during the greater part of the development period, 
have become more or less set, and extension is difficult and paim 
ful when the erect position is attempted. 

Support from the Pelvis More Natural. —An artificial leg 
applied to a child, no matter how young, supplies a support to 
the amputated side that is the nearest approach to nature. It 
gives freedom to the arms, the joints and muscles are kept in ac¬ 
tivity. Being propped from the pelvis instead of from the shoul¬ 
ders, the spine, chest, and shoulders are not distorted, but are as 
free to perform their functions as if the child had never lost a 
limb. All the parts of the body maintain their proper relations 
and develop symmetrically. 

The child invariably becomes expert in the use of one or a pair 
of artificial limbs, if applied soon after amputation; he mingles 
with other children, and engages in the same sports and exercises, 
the variety, which makes him strong mentally and physically, 
keeps him healthy, and prepares the foundation for the vigorous 
manhood and active life before him. 

Alterations for Growth.—A child will outgrow his artificial 
leg, but this does not entail a serious loss; the leg can be 
altered in length and size to accommodate his growth and devel¬ 
opment. The expense attending such changes is not large, no 
greater than that of changing or renewing crutches, or repairing 
rolling chairs. 

The only growth of the child that affects the length of the arti¬ 
ficial leg is that which takes place in the sound leg from the 
knee to the floor. A child may, in the course of two years, grow 
four inches in his entire height, but the growth in the sound 
leg, from the knee to the floor, will be less than an inch. It is, 
therefore, evident that a child growing four inches in height will 
not require his artificial leg to be lengthened over an inch. 

Frequency of Alterations. —The frequency with which an 
artificial leg worn by a child is lengthened, is about once in two 
years, oftener if the growth is more than usually rapid, and the 
expense attending each lengthening is not over $5.00. In fam¬ 
ilies where economy has to be exercised to an extreme degree, 
the lengthening of the leg can be deferred, if necessary, by in¬ 
creasing the thickness of the sole and the heel on the shoe worn 
on the artificial foot as soon as growth requires. The size of the 
leg can be increased, and the foot can be enlarged, and in this 
way the leg can be made to last from five to ten years. It will 
thus be seen that in extreme cases a child can be supplied with 
an artificial leg, and the leg can be kept in proper length, at an 
expense of about $2.50 a year. We can hardly conceive of a 
parent who is so poor that he cannot meet this expense, or wh<? 



A. A. Marks , Artificial Limbs , New York City. 153 


is so heartless that he would see his offspring hobbling about on 
crutches during his youth merely to save so small an expenditure. 

The Parents’ Moral Obligation. —Duty is the most impor¬ 
tant matter to be considered. All parents are bound by the 
laws of nature, as well as by those of the State, to perform 
those services that will protect the health and comfort of their 
offspring, to care for them in sickness, to lessen their afflic¬ 
tions, and alleviate their sufferings. It seems a flagrant violation 
of these laws for a parent to require his child to go on crutches, 
subjecting him or her to the dangers of impaired health and 
arrested development, when an artificial leg can be easily ob¬ 
tained and cheaply maintained, a leg that will perform such im¬ 
portant work in ameliorating the child’s condition. An artificial 
leg should be regarded as indispensable, more important than fine 
clothing, and next to the food that is required to sustain life. 
No conscientious parent, in viewing all the facts connected with 
this important subject, can hesitate in deciding on what course 
to pursue. If financial resources are limited, there should be no 
disgrace felt in calling upon friends for assistance; the urgency 
is too great to be neglected through scruples. The child must be 
rescued from a life of torture and embarrassment, and the parents 
must act to save themselves the censure and rebuke that neglect 
of this kind will bring in later years. 

Deformities from the Use of Crutches. —Look at the child 
who is required to go about on a pair of crutches (Cut M 1). 



Cut M 3. 


Cut M 2. 


Cut M 1, 


See how the shoulders are pushed upward, how the head leans 
forward, the chest sunken, and how generally disfigured he ap¬ 
pears. Look at the child who hobbles about on one crutch (Cut 
M 2), see how one shoulder is raised higher than the other; how 









154 A. A. Maries , Artificial Limbs, New York City. 


the body is thrown to one side, the sound leg deflected, the neck 
crooked. Now, look at the child who has been cared for hu¬ 
manely (Cut M 3), who has been given an artificial leg and 
propped in a natural way on the amputated side. 

He is the picture of symmetry, his health is robust. No 
one would suspect that anything unusual had occurred to him, 
his artificial leg performs the functions of the lost one. He has 
forgotten his loss, and never admits his disability. He does every¬ 
thing his companions do; he is in the ball game with them, he 
rides the bicycle, skates, dances, and is not denied a single privi¬ 
lege belonging to those in possession of their natural extremi¬ 
ties. “ To clinch the nail of theory with a few blows from the 
hammer of experience ” we cite a few cases that have come 
under our observation. 

Practical Illustrations.-- -Cuts M 4 and M 5 portray Mabel 
T., who, when less than nine months old, had her left leg ampu- 



Cut M 4. 


Cut M 5. 


tated very close to the knee. After recovering from the operation, 
it was discovered that the tendons of the knee were contracting 
and the stump being drawn into a flexed position. The mother 
became alarmed and consulted her physician. It was feared that 
if the child was permitted to continue as she was, she would, 
in a short time, lose the use of the knee joint. She had not be¬ 
gun to creep. It was evident that if an artificial leg were ap¬ 
plied, the stump would be forced into such activity that the' 
knee mobility would be preserved, and one was obtained. The 









A. A. Marks, Artificial Limbs, New York City . 


155 


socket was made to fit the stump snugly, the joints were placed 
on the sides to harmonize with the natural knee joint; a thigh 
piece incased the thigh. The leg would swing when the child 
was carried, and forced the stump to move at the knee. 

In a few months the child began to creep. The mother was 
surprised one morning to find her standing by the chair, put¬ 
ting some of her weight on the leg. It was not long before she 
began to walk, then to run and play. The leg was lengthened 
quite frequently, and enlarged several times. During her child¬ 
hood she ran and romped about as other children, went to school, 
and was as happy as any of her companions; she is now a young 
lady of twenty-two. Although her parents were in moderate 
circumstances, they always felt that their daughter’s health and 
perfect development were important, and they denied themselves 
many things, but considered themselves amply compensated for 
the care they had given to the needs of their daughter. 

Carrie K., when seven years of age, was run over by a carriage 
and lost her left leg. An artificial one was applied as soon as 
the stump had healed. The distinguished Dr. James Knight, 
the founder of the Children’s Hospital in New York City, took 
the case in hand, and realizing the importance of putting the 
child on a leg instead of keeping her on crutches, interceded in 
her behalf. A leg was applied and she grew up with it; she de¬ 
veloped gracefully and now is a woman of forty-three years. Cut 
M 6 represents her as she appeared when brought to us in 1869. 
Cut M 7 represents her with artificial leg applied, and Cut M. 
8 gives her as she appears to-day, a thankful wife and a happy 
mother. 

Thomas Kehr, when eight years of age, was run over by the cars, 
both of his legs were crushed, the right was amputated four inches 
below the body, and the left two inches below the knee. As 
soon as the child recovered from the operation Dr. Samuel J. 
Brady, of Brooklyn, advised that he be provided with a pair of 
artificial legs with rubber feet. They were obtained and ap¬ 
plied, and the manner in which the young man got along is 
clearly stated in Dr. Brady’s letter of 1876, from which we make 
the following extract: 11 1 have thoroughly examined the case of 
the boy Thomas Kehr, who has been wearing a pair of artificial 
legs for six months. About a year and a half ago he was run 
over and both of his lower limbs were so crushed that I ampu¬ 
tated them, the one well above the knee, the other an inch and 
a half below. At the time of the operation many expressed the 
wish that death would occur, as the lad being very poor, it was 
thought that his future would not only be a burden to himself, 
but that his support, should he reach man’s estate, would de¬ 
pend upon the charity of the public, as it was considered an 
impossibility for him to serviceably use artificial limbs. 

“ I am thankful that I can say that Marks’ artificial legs have 
made his future worth the living. 

“I saw him two weeks after he had put the legs on for the 



156 A. A. Marks , Artificial Limbs, New York City . 


first time, and it astonished me greatly to see the remarkable 
use he had so soon acquired; since then I have seen him many 
times, and quite recently I saw him walking without the use of 
canes. He has, much to my astonishment, been fully and abso¬ 
lutely restored. 

“ I attribute the wonderful success in this boy’s case mainly 
to the superior results achieved by your inventions, and to the 



Cut M 6. Cut M 7. Cut M 8. 


fact that the legs were put on so soon after the amputations that 
the stumps had not had a chance to forget their functions.” 

Mr. Kehr is now a man of forty years. He is an active, cap¬ 
able, energetic workman, in perfect health, earning his livelihood 
and maintaining a family. If this man had been neglected in 
his childhood, he would be to-day a helpless object of pity, instead 
of a self-supporting member of the community, 

Annie L. Beckwith lost her leg below the knee in 1887, when 
she was seven years of age. An artificial leg was immediately 
applied. It has been lengthened several times since. She is now 
a woman of good proportions, strong and healthy. Cuts M 9 
and M 10 represents her as she appears without and with her 
artificial leg. 

Manuel Parraga, of San Salvador, Central America, had his leg 
amputated above the knee in 1876, when eleven years of age. 
An artificial leg was applied immediately. His weight at the 
time was seventy-five pounds. The lad has developed into a full- 

















A. A. Marks , Artificial Limbs , New York City. 


157 


grown man, weighing two hundred pounds. He is strong, healthy, 
and has a model stump, and walks about in the most natural 
way. In a letter recently addressed to us he says: “For a long 
time I have been desirous of writing to you and expressing my 
continued satisfaction in the work that you have done for me. 
Since I have returned to Central America I find it necessary to 
make long journeys on horseback. The artificial leg assists me 
very much. I pride myself on my easy and graceful movements, 
and the facility with which I mount and dismount. The India- 



Cut M 9. Cut M 10. 


rubber foot on the artificial leg is a most excellent invention; 
without it I question my ability to walk with safety in this 
country, where the streets are so rough and stony.” 

John Jerome Booth, son of Dr. J. P. Booth, had his leg ampu¬ 
tated when seven years of age; railroad accident. An artificial 
leg was applied when he was eight years old. He then weighed 
fifty-seven pounds. The young man has grown and developed 
symmetrically and is now twenty-four years of age. He refers 
to the early application of his artificial leg as an exhibition of 
good judgment on the part of his father, for which he feels 
greatly indebted. He says that if he had been neglected when he 
was young, he would not be in possession of his present strength 
and proportion. 

George G. Griswold had the left leg. amputated below the 
knee when twelve years of age. An artificial leg was applied 




158 A. A. Marks , Artificial Limbs , New York City. 


within a year after amputation. We quote from a letter writ¬ 
ten by his father. “ The leg was applied to my son when he was 
less than thirteen years old, fitted from measurements without 
requiring his presence, has been in constant use. I hardly know 
of anything that he cannot do that other boys of his age can with 
sound limbs. He walks, skates, plays ball (Cut M 11), and 



climbs trees. When he was sixteen years of age we moved to 
another town, and for about a year scarcely a single schoolmate 
or neighbor ever suspected that he wore an artificial leg. I do 
not think it is possible to find an artificial leg equal to that which 
you construct for young and growing children. I have never re¬ 
gretted having applied an artificial leg to my son on account of 
his tender age.” 

William T. Wilson, when fifteen years of age, was run over by 
a railroad car and had his leg mangled so greatly that amputa¬ 
tion was necessary. A few months after an artificial leg was 
applied. He weighed one hundred and ten pounds, and was at 
the period of life when growth and development promised to be 
rapid. The artificial leg was lengthened twice in four years. 

James Good, at the age of thirteen, was run over by the cars 
and the left leg amputated below the knee. Seven months after 
amputation an artificial leg was applied; age fourteen, weight 
eighty pounds. The boy has grown to a man of large proportions, 
and at this writing is a locomotive engineer. 


























A. A. Marks, Artificial Limbs, Mew York City. 159 


George W. Sheridan, son of General George A. Sheridan, 
was thrown from a carriage by a runaway horse, when he was ten 
years old. One leg was crushed and had to be amputated below 
the knee. Nine months later his mother, becoming solicitous 
about the child’s development, insisted on an artificial leg being 
obtained, this in opposition to the advice of her husband and 
family medical adviser. The mother gained her point, and a leg 
was applied, and the child used it immediately, and the effect 
upon his health was surprising. We quote from the General’s 
letter: “ My son is now fifteen years of age. He has worn a leg 
of your make for the last five years, always with comfort and 
satisfaction. When visiting him at his school a while since, I 
found he was out for a day’s fishing. When he returned and 
stated where he had been, the teacher remarked that he had walked 
at lease ten miles. George skates on steel or roller skates, rides a 
bicycle, and in short enjoys to the full the usual sports of boys 
of his own age. I now realize that it would have been a mistake, 
almost a c;ime, to have made the boy wait until he had stopped 
growing before supplying him with your artificial leg.” 

Hattie L. Moore had her leg amputated at the age of thirteen. 
Six months after the operation an artificial foot was applied. 
She wore it five years without lengthening. The growth of the 
natural foot, from the ankle down, was not great enough to re¬ 
quire any alteration in the artificial foot. We quote from her 
letter: “ My foot was amputated when but a child of thirteen, 
and as soon as the stump had healed, I had one of your admi¬ 
rable rubber feet supplied, made and fitted from measurements. 
It fitted me as if I had gone to New York and had had the foot fit¬ 
ted by your own hand. I have used the foot four years now, to the 
untold satisfaction of myself, and the utmost gratification of my 
friends, who often tell me that they would never notice anything 
peculiar about my walk. I have lived with people nine months 
without their discovering that I was lame. 

u I am at present doing a daughter’s part of housework, stand¬ 
ing on my feet the greater part of the time.” 

William E. Shaw, leg amputated for injury to the knee. An 
artificial one was applied when nine years of age. To quote from 
his father’s letter: <( My boy has had great -success with the arti¬ 
ficial leg that you made for him. He can walk and get about 
excellently. He would not be without it for anything. It is un¬ 
questionably the best thing for a child, when he has lost one of 
his legs, to get an artificial one without delay.” 

John Kershaw, leg amputated above the knee, railroad accident. 
Artificial leg applied when ten years of age, immediately after 

the healing of his stump. . 

Dr. A. C. Dedrick writes: “I passed John Kershaw in the 
street three months ago. From the success in his case I certainly 
advise the application of an artificial leg to a young and growing 
lad as soon as the stump has healed. John Kershaw has been 
able, thanks to the artificial leg, to enjoy his early life equally 



160 A. A. Marks , Artificial Limbs, New York City. 


with others not so unfortunate. He plays football, baseball, 
and all other sports. I think he would have lost all power of 
stump if the leg had not been employed. The stump is only 
about six inches long, and would in all probability have become 
flexed if he had grown older without a leg to keep the hip joint 
in condition.” 

Flossie Lee, leg amputated below the knee. Artificial leg ap¬ 
plied when four years of age. Dr. G. A. Harris, of Chepachet, 
R. I., writes, “ Flossie Lee has worn an artificial leg, which you 
fitted her five years ago, continuously since that time, except 
when sent to you for lengthening. It is needless to say that her 
health, in both mind and body, is different from what it would 
have been had she been confined to the house all these years. 
She has been to school, and runs about like other children, 
which means everything to a growing child. No change has 
been made in the leg all these years, except the increase in 
length.” 

Thomas McAleer, leg amputated above the knee on account 
of accident. Artificial leg applied when seven years of age. Dr. 
D. K. Dickinson writes: “McAleer, whom you so nicely fitted 
with an artificial limb for amputation above the knee joint, 
has received great satisfaction. I recommend the application of 
a limb by all means in similar cases.” 

Ettie Stangl, leg amputated below the knee in 1889. David 
Jones, of Richardson County, Neb., writes in regard to the case: 
“Ettie Stangl, to whom you applied an artificial leg when she 
was very young, has worn it continually. She does not appear 
like a cripple, she moves about so naturally. I can say that the 
artificial leg was a source of comfort to her, and I think provid¬ 
ing her with the limb when she was so young was the best thing 
that could be done for her health and comfort.” 

Mary Wiley, both feet amputated in 1891; cause, railroad acci¬ 
dent. Artificial feet were applied several months later. She was 
then eight years of age. This little girl is a forcible example of 
the wisdom of applying artificial limbs to children, especially 
when both are amputated. 

Clarence Wintersgill, both legs amputated; right, six inches be¬ 
low, and left, three inches above the knee; cause, railroad accident. 
Artificial legs applied within a few months. Age, seven. Dr. 
R. F. Wintersgill writes as follows: “ In regard to my son’s case, 
the application of a pair of artificial limbs has been a wonderful 
success. He was but seven years of age when you made his 
limbs, but learned rapidly how to use them. He now skates, rides 
a horse, goes to school, and walks several miles without resting. 
I was advised not to get Clarence any limbs until he had ceased 
growing and had almost made up my mind to wait, but to look at 
my little child sitting out in the yard helplessly, and to think that 
he must do so until he had finished growing, made me almost 
frantic. In the meantime, one of my neighbors provided me with 
one of your books, and I studied it day and night until I came to 



A. A. Marks, Artificial Limbs, New York City. 


161 


the conclusion to try a pair of your legs, with the results men¬ 
tioned above. 

“You will remember, Clarence’s left leg is off above the knee 
and the right below the knee. He was wearing his artificial 
limbs one year after amputation, and if I had to do it over again 
he would wear them in one month.” 

John E. Palmer, leg amputated below the knee. Artificial leg 
applied within six months; age, nine years. His father, Bradford 
Palmer, writes: “I am glad to let you know what success my boy 
has had in using his artificial leg. He was only nine years old 
when he commenced wearing it. I can say that it has afforded 
him the greatest satisfaction, and he could in no way be induced 
to do without it. He is growing fast and has the best of health.” 

Anton Gaub, leg amputated in 1884. Artificial leg applied 
within a few months after amputation; age, four. Gaub is now 
(1905) twenty-five years of age, full grown and well developed. 
He has always used the leg and never cared for crutches. He is 
strong, in good health, and walks great distances without becom¬ 
ing fatigued. He is actively engaged in business. His parents 
refer with pride to their decision in putting him on an artificial 
leg when he was so young. 

Roscoe E. Bosworth, leg amputated below the knee in 1890; age, 
nine years. His father, Levi Bosworth, of Worcester County, 
Mass., writes: “ I consider that it was a very wise thing on my 
part to have supplied my boy with an artificial leg when he was 
so young. He now has full use of his knee and hip joints, which 
I think would have become greatly impaired if he had not used 
the leg. He is now in good health, well developed. Crutches, 
which he used for a short time, always made him sick. 

“Roscoe has skated, ridden a bicycle, and done almost every¬ 
thing other boys do. If I had a child only two years of age and 
he needed an artificial leg I would put one on immediately.” 

Roy V. Bryant, leg amputated above the knee when seven years 
of age; artificial leg applied immediately. His father writes as 
follows: “ My son has worn his artificial leg constantly, with the 
exception of times when it has been at your factory for lengthen¬ 
ing. He is now twenty years of age. He has grown straight, 
strong, muscular, well developed. I am thoroughly convinced, 
from the experience in my own son’s case, that an artificial leg 
cannot be applied when a child is too young.” 

Carl T. W. Banks, leg amputated above the knee; railroad 
accident; artificial leg applied within six months after amputa¬ 
tion. His mother writes: “ The question of applying an artificial 
leg to a young child was one of great thought to me. Many of 
my friends thought it unwise to do so, but I could not bear to 
see my son Carl going on crutches, so I got a leg and had it put 
on when he was only seven years old. He has been wearing it 
since, and he is now well developed, strong and healthy. During 
his childhood days he played with other boys, in all kinds of 
weather and at all kinds of games.” 



162 A. A. Maries, Artificial Limbs, New York City. 


Emma Zern, leg amputated above the knee. Dr. J. William 
Trabert, of Annville, Pa., writes: “Emma Zern’s leg was ampu¬ 
tated in the lower third of the thigh in 1890, when nine years of 
age. She received an artificial leg from you within six months. 
She has been wearing the same constantly. In the following 
spring she grew 2^ inches. The leg had to be lengthened, but 
it did not cost very much to do it. 

“At first I was doubtful that a child of her age should have 
an artificial limb, but am now convinced that a child cannot be 
too young, as this case has shown.” 

Nellie Cartwright, at the age of eleven, met with an injury to 
her leg that necessitated an amputation below the knee. Six 
months after an artificial limb was applied. Her father writes: 
“ I purchased an artificial leg from you for my daughter in 1893. 
She was then eleven years old. She has used the leg constantly. 
I am delighted with the results and prepared to say that I rec¬ 
ommend the use of artificial limbs to children of any age, and 
the sooner the child has a leg applied after losing a natural one 
the better it will be for that child. There are two reasons that 
should induce a parent to act promptly: First, an artificial leg 
enables a child to walk naturally, promoting good health and 
symmetrical growth. Second, a child becomes accustomed to the 
use of the limb while young and active and will ever afterwards 
use it with better results than it could if the use was delayed until 
maturity.” 

Clara Giere, leg amputated below the knee; age, eight. An arti¬ 
ficial leg was applied immediately. Dr. E. Alonzo Giere, of Hay- 
field, Minn., writes: “ The artificial leg which I obtained for Clara 
has given good satisfaction. The child has grown and the leg 
has had to be lengthened. She is still using it with comfort.” 

Dr. A. R. Eaton, of Elizabeth, N. J., under date of March 31, 
1904, writes: “ The facts of my case are as follows: In March, 
1891, I had my left leg so badly crushed as to require a supra¬ 
condylar thigh amputation (Gritti-Stokes type). In May of the 
same year I applied one of your artificial legs and wore it for a 
considerable length of time. Since I have attained my growth 
I have had another one made. The leg was a blessing to me from 
the start. As a matter of fact, I would have been lost without it 
at any time. I walk easily long distances, sometimes ride a bicy¬ 
cle, other times ride a horse; I play tennis, golf, etc. In fact, do 
with ease and facility almost all ordinary things. 

“My observation leads me to believe that this excellence of 
locomotion is only possible with the Marks leg, for I see cases 
similar to my own using ankle-joint legs who are able to enjoy 
only ordinary usefulness. 

“In regard to the application of artificial legs to young and 
growing children, I can say that my own case is an example. The 
artificial leg was applied when I was thirteen years old. I am 
now fully grown and am a physician engaged in active prac¬ 
tice. My professional knowledge tells me that it is a most advis- 



A. A. Marks, Artificial Limbs , New York City. 


163 


able procedure, for the use of a leg strengthens the stump, pre¬ 
vents atrophy of joint structures and soft parts, and trains a child 
in the use of a leg, and when he reaches adult life he will have 
perfect control over it, and he will become strong and healthy.” 

Charlie Moore, at the age of eight, had his leg crushed by a 
wagon. Amputation was above the knee. His mother writes: 
“ My little son, Charlie Moore, when eight years of age, met with 
an accident that resulted in the amputation of his right leg. He 
went on crutches two years. He was pale and sickly and grew but 
little. The doctor said he was sure that the constant use of 
crutches would induce spinal disease or lung trouble. I there¬ 
fore resolved to get an artificial leg for him. I did so, and 
as a result he now has good health, is well grown and thoroughly 
developed. I advise buying your make of artificial limbs for 
young and growing children. They are light and strong in con¬ 
struction and easily lengthened.” 



CHAPTEB XV 

HOME MEASUREMENTS 

Our system, devised and inaugurated years ago, by which 
measurements and diagrams for artificial limbs can be taken at 
home by the family physician or the subject himself, assisted by 
some member of his family, and our method of fitting and con¬ 
structing artificial limbs from such data, have proved so satisfac¬ 
tory that we encourage those desirous of saving long, tedious, and 
expensive journeys to have their limbs made from measurements 
while they remain at home. 

This feature has placed our facilities and skill within reach 
of those who are in need of artificial limbs, no matter how distant 
they may reside from us; it affords an opportunity to obtain the 
best at the least possible expense and trouble. 

So successful have been the results obtained from this method 
that expressions of gratitude and commendation have come from 
the most distant parts of the world. Men of prominence, as well 
as those not so frequently in public mind, have benefited by the 
plan. 

We have customers living within a few miles of New York 
City who are so actively engaged that they prefer to have their 
limbs fitted from measurements under the guarantees we give, 
rather than absent themselves from their homes. 

To encourage persons to have their limbs made in this way, we 
agree to make all changes or reconstructions without charge, 
whether such are required on account of errors in measurements 
or changes in stumps, or any other cause whatever. 

If anyone desires to be present at the fitting, we will not dis¬ 
suade him from his intentions, and will give him immediate 
attention on his arrival. 

As soon as measurements and diagrams are received, we subject 
them to the closest scrutiny, and if errors or omissions are dis¬ 
covered, they are returned for corrections, and if there are any 
indications that successful fittings from measurements are doubt¬ 
ful we do not hesitate in notifying the party to that effect. As 
soon as we accept the data we assume all risks, we make the leg 
accordingly and forward it to the client with full instructions for 
its application. Should it fail to fit properly, it can be returned 
with particulars, and we will alter or reconstruct it without 
charge. 


A. A. Maries , Artificial Limbs , New York City. 165 


INSTRUCTIONS WHEN ONE LEG IS AMPUTATED 

Diagrams. —First, make a diagram of both the sound and ampu¬ 
tated legs. This is done by removing the clothing and sitting 



Cut N i. Cut N 2. 


on a large sheet of paper, with both the sound leg and the stump 
extended and slightly spread apart, the foot pointed directly 



Cut N 3. Cut N 4. 

upward. Beginning at the body, draw a pencil down the outside 
of the sound leg from the hip, around the heel and up the inner 




Cut N 5. Cut N 6. 

side to the body. Then carry the pencil down the inner surface 
of the stump and around the outer side to the hip. Cuts N 1 and 
N 2 show the manner in which this is done if the amputation is 

















166 A. A. Marks f Artificial Limbs, New York City. 


below the knee; Cuts N 3 and N 4 show the same if the amputa¬ 
tion is in or above the knee. For side diagrams, it is necessary 
for the patient to lie on one side with the knee bent at right 
angles and then pass the pencil around the leg, as shown in Cut 



Cut N 7. Cut N 8. 


N 5. If the amputation is below the knee, turn on the amputated 
side, resting the exterior surface of the stump and thigh on the 
paper, and mark around it, as shown in Cut N 6. Then, without 
changing the position of the body, flex the knee to about right 
angles, and mark around the thigh and stump, as illustrated in 



Cut N 7. These diagrams will show the amputated leg in two 
positions, one with the stump fully extended, and the other flexed 
at right angles. If there is a limited motion in the knee joint, 
special care must be taken that the limits of extension and flexion 









A. A. Marks, Artificial Limbs , New York City. 167 


are shown in the diagrams. Then place the foot on the paper and 
draw a line around it, as shown in Cut N 8. 

Measurements. —After the diagrams come dimensions. Meas¬ 
uring should be done in the morning when the stump is not 



Cut N 11. 



swollen; a tape line should he used. Begin with measuring the 
distance from the crotch, or perineum, to the floor—the end of 
the tape line must be put close to the body between the legs and 
tarried vertically down to the floor (see Cut N 9); in the same 




Cut N 18. 


Cut N 14. 


way measure the distance from the crotch to the end of the 
stump (see Cuts N 10 and N 11). Measure fromthe end of the 
stump to the floor, as shown in Cut N 12 or Cut N 13. 

While still standing take the circumferences of the sound thigh. 













168 A. A. Marks, Artificial Limbs , New York City . 


beginning close to the body, as shown in Cut N 14, repeat at 
points two inches apart, until the knee is reached, then take the 
circumference of the knee around the knee-cap, then the following 



Cut N 15. Cut N 16. 

circumferences; the leg immediately below the knee-cap, the calf, 
smallest part of the ankle, just above the joint, the heel and 
instep, the instep, the foot at the base of the toes; then measure 
the length of the foot. 

If the amputation is below the knee, take the circumference of 
the thigh close to the body (see Cut N 15) and repeat these cir- 



Cut N 17. 



cumferences at points two inches apart until the entire thigh is 
measured; then take the circumference of the knee around the 
knee-cap; then take the circumferences of the stump, beginning 
immediately below the knee-cap, and repeating at points two 
inches apart until the entire stump is measured. If the amputa¬ 
tion is in or above the knee, take the circumference close to the 









A. A. Marks , Artificial Limbs , New York City. 


169 


body and repeat at points two inches apart until the entire stump 
is measured. 

After the circumferences have been taken, measure the distance 



from the top of the knee of the sound leg to the floor when seated 
in a chair, with the leg bent at right angles (see Cut N 16). 



Write all these lengths and 
their respective places. 



Cut N 26. 

circumferences on the diagrams in 












170 A. A. Marks, Artificial Limbs, New York City. 


If correctly made, the diagrams of an amputation below the 
knee will resemble those figured in Cuts N 17 to N 20; for ampu¬ 
tation in or above the knee they will resemble Cuts N 21 to N 24. 

Other required measurements include the height of the person 
when standing erect on the sound leg. This can be taken by 
standing against a wall and the height marked by a book or car¬ 
penter’s square (see Cut N 25); the distance from that point to 
the floor should then be carefully measured; then sit on the bare 
floor, with the back against the wall, and note the height from 
the top of the head to the floor, as shown in Cut N 26. 

These heights are wanted to verify the length given of the leg. 
The height from the head to the floor when sitting subtracted from 
the height when standing is equal to the length of the leg. 

INSTRUCTIONS WHEN BOTH LEGS ARE AMPUTATED 

If both legs are amputated, either above or below the knees, or 
if one is amputated below and the other above, it is necessary to 
make diagrams of each stump and thigh, presenting both front 
and side views, with knee joint extended and flexed to as near 
right angles as possible. These can be taken by disrobing and 



Cut N 27. Cut N 28. 


sitting on a piece of paper with the stumps extended and marking 
around them from body to the ends with a pencil held perpendicu¬ 
larly (see Cut N 27). Then turn to one side so that the exterior 
surface of the thigh and stump will rest on the paper; the stump 
extended, mark around the thigh and stump, then bend the knee 
to about right angles and mark around thigh and stump (see Cut 
N 28). A similar diagram must be made of the other thigh and 
stump (see Cut N 29). After these diagrams have been made, 
circumferences should be taken by passing a tape line around 
each thigh, close to the body, and repeating at points of about 
two inches apart until the thighs and stumps have been measured. 
Care should be given to take the measurements when the stumps 
are not swollen and to draw the tape line moderately tight, as 
shown in Cuts N 30 and N 31. Write all the measurements in 
plain figures in their respective places on the diagrams. Sit on 





A. A. Marks, Artificial Limbs, New York City. 171 


the floor, with back against the wall, and mark, by book or square, 
the distance from the top of the head to the floor, as illustrated in 
Cut N 32. Send this measurement, together with former height, 




Cut N 29. Cut N 30. 

that is, the height before amputation. If the full former height 
is to be restored that fact should be noted. 

Stumps that reach to the ankle joints or knee joints should be 
reproduced in plaster. 

The following questions should be answered in every case: 
Name of patient? Post-office address? Occupation? Age? 




Cut N 31. Cut N 33 - 

Weight? Cause of amputation? When was the amputation per¬ 
formed? Which leg amputated? Has an artificial leg been worn? 
For how long ? Name of the party ordering the leg ? His address ? 
Is the leg to be made and fitted from measurements in the 
absence of the patient? 





172 A. A. Marks , Artificial Limbs, New York City. 


If it is proposed to take weight on the end of the stump, that 
fact should be noted. 

If the amputation is in the ankle joint or in the foot, the 
diagrams and measurements are the same as are required in 
amputations above the ankles. 

Plaster Casts. —Plaster casts are only required of stumps that 
reach to the articulations (knee or ankle joints) or in the feet, 
and of deformed limbs, and of amputations that have resulted 
from deformities. 

The method of making a plaster cast depends upon the condi¬ 
tion of the stump. For tapering stumps, the following is the 
simplest: Remove the clothing, shave all hair from the stump 
or fasten it down with paste, or thick soap, as otherwise it will 



Cut N 33. Cut N 34. 

cling to the plaster. Then take two quarts of thick, quick-drying 
plaster of Paris, such as used by dentists, put a quart of water 
in a bowl and sprinkle the dry plaster in it, mix thoroughly. It 
should be made about as stiff as “ pancake dough; ” then spread 
it over all sides of the stump to the thickness of at least half 
an inch. The stump must be held perfectly still until the plaster 
has become hard, which will be about ten minutes. Then draw 
it from the stump and the inside will be a counterpart of the 
stump. 

If the stump is larger at the end than immediately above, as in 
the case of partial foot, ankle-joint, or knee-joint amputations, 
the plaster must be broken off in large pieces and put together 
after the stump is removed, or the string method can be used, as 
follows: A piece of strong, thin cord is passed loosely up each 
side of the limb (see Cut N 33), to which it is made to adhere 





A. A . Marks, Artificial Limbs, New York City. 


173 


by thick plaster (see Cut N 34). Work quickly, using about four 
quarts of slacked plaster and cover the entire limb to a thickness 
of not less than half an inch. As the leg must be held vertically. 



Cut N 35. Cut N 36. 


the plaster must be quite thick, otherwise it will flow down. Every 
part, the back, sides, front, and end, must be liberally covered. 
As soon as the plaster has become a little set, the string can be 



Cut N 37. 



pulled gently downward (see Cut N 35), cutting the mold into 
longitudinal parts. It must now be left alone, so as to thoroughly 
harden, which will take about ten minutes; the mold can then be 

















174 A. A. Marks , Artificial Limbs, New York City. 


separated on the line cut by the string and the two parts 
removed (see Cut N 36). These parts can then be greased or 
oiled on the inside and put together and bound with a string; the 
inside .can then be filled with thin plaster of Paris (see Cut N 37). 
When the mold is filled, it should be laid aside for several hours, 
when it will have become so hard that the shell will yield to slight 
pressure and break off, uncovering a facsimile of the stump. 



Cut N 39. Cut N 40. 


The plaster bandage method is an excellent way of taking a 
cast of a flabby and tapering stump. A sheet of old muslin or 
cheesecloth is cut into strips about two inches wide and sewed 
into lengths of about twelve feet long. Three such strips are 
usually needed. Dry plaster should be spread on the strips which 
are then rolled up very tightly (see Cut N 38). No more plaster 



Cut N 41. 


should be put on than will fill the meshes. The stump should be 
prepared by removing the hair or fastening it down with paste or 
thick soap. The plaster bandage roll must be immersed in water 
and allowed to remain until the bubbles cease to come to the 
surface (see Cut N 39). It is then taken from the water and 
wrapped around the stump while being unrolled, beginning at 
the eud of the stump and continuing to a little above the knee 






A. A. Maries, Artificial Limbs, New Yorh City. 


175 


(see Cut N 40), then work down and up again, covering the 
stump with three or more layers or until all the bandages have 
been used. Allow the bandage to remain on the stump until it 
becomes hard, when the stump can be withdrawn (see Cut N 41). 
The plaster bandage will form a mold of the stump, which can be 
sent to us as it is, or it can be greased and filled with slacked 
plaster, and a true cast made, as previously described. 

Casts and molds should be sent packed in sawdust to prevent 
breakage. If shells are sent, they must be filled with sawdust, to 
prevent collapse in transit. 

Prices for artificial legs, feet, etc., will be found in chapter 
placed at the back of this book. These prices are subject to change 
according to changes that take place in costs of material, labor, etc. 

Accessories. —Needful supplies, as indicated below, are furnished 
without extra charge. 

Artificial Foot for partial foot or ankle-joint amputation. A 
suitable sock for the stump. 

Artificial Leg for below-knee amputation. A suitable suspender, 
one long and one short stump sock, screwdriver and lubricant for 
knee joint. 

Artificial Leg for all other amputations. A suitable suspender, 
one sock for stump, lubricant for the knee-joint, screwdriver, extra 
spring. 

Terms of Payment. —Payment should be in advance with every 
order. If preferred, one-half can be advanced and the balance paid 
on delivery. This is the plan on which payments are reasonably and 
properly required on all articles that are made to order. 

Guarantees. —A guarantee for a period of five years covering 
material and construction is given with each leg. 



CHAPTER XVI 


WHEN EXTREME CONSERVATISM IN AMPUTATIONS 
BECAME A MENACE 

By GEORGE E. MARKS, A.M. 

Amputations are made to save life, relieve pain, or to detach a 
useless member. Trauma, disease, neurotic afflictions, paralysis and 
deformities come within the list of causes. 

For years the thought that amputations should be made with the 
least sacrifice governed the operations of the surgeon, and so deeply 
has this been welded into text books, that even to-day prothesis is 
too frequently ignored and long troublesome stumps the sequence. 



I was requested by the late Dr. J. MacDonald, Jr., to prepare an 
article in which the errors of excessive conservation might be pre¬ 
sented to the readers of the American Journal of Surgery. I pre¬ 
pared the article and it appeared in that journal, September 1907. 
That article was extensively quoted. Although seventeen years have 
elapsed it is still received with favor by the profession and fre¬ 
quently referred to and copies are sought. 

176 








A. A. Marks, Artificial Limbs, New York City. 177 


I have taken the liberty of revising that article and am now 
distributing it with the hope that it will modify the practice of 
“ least sacrifice,” and encourage an aim for stumps of the most 
efficient capabilities. 

The cases cited below are actual, each has been under my observa¬ 
tion. 

No. 1. Oscalcis partly removed, all other bones of the foot re¬ 
maining. The oscalcis is required to hold the Tendo-Achilles. As 
soon as that fastening is destroyed, or its power weakened by 
shortening the “ lever,” the ankle joint ceases to function with 
strength sufficient to elevate the body, in consequence walking is 
proportionately impaired. 



The operation damaged the protective tissues of the heel, pre¬ 
venting impact with any medium calculated to fill the heel part of 
a shoe. The only appliance I could devise was an encasement for 
the foot, carried well up on the leg, allowing the weight to be applied 
to the ball of the foot. This appliance was somewhat cumbersome, 
not very shapely and, in order to have the required strength, was 
unavoidably heavy. Amputation of the foot at the ankle after the 
Symes method would have brought more comfort, more efficiency 
and less expense to the subject. If heel flap was doubtful, amputa¬ 
tion at point of election A-A would have been better. 

No. 2. Foot lacerated, bones crushed. The surgeon removed the 
front part of the foot and the entire oscalcis. The prospect of 
equipping this person with a helpful artificial foot was problematic. 
It was, however, accomplished with indifferent results compared 
with those that would have followed if the amputation had been 
at the ankle Symes or Pirogoff A-A. 











178 A. A. Marks, Artificial Limbs, New York City . 


No. 3. An amputation at the instep, back of the flexor fastenings 
will put the ankle entirely under control of the Tendo-Achilles, 
when this tendon is not opposed, the heel will be drawn out of place. 
The severing, or lengthening of the tendon is only a temporary 
expedient, sooner or later the tendon will unite or shorten, and 
influence the heel away from the place at which it can support 
weight. If the flexors cannot be saved and function it is better 
to amputate in the ankle joint. Line A after the Symes or Pirogofli 
methods. 



Fig. 3 


No. 4. An amputation in the foot removing all the bones, with 
the exception of the Astragalus. I have never known good results 
to follow an operation of this kind unless the Astragalus is fixed 
and covered by a substantial heel flap. An articulating Astragalus 
no matter how well it may be protected by flap is not productive 
of the good results. It is safer and better to amputate at the ankle 
after the Symes or Pirogofli method. 

No. 5. An amputation of the foot very close to the ankle articula¬ 
tion is not well advised. The tiba at the ankle, is very small and 
very poorly protected by tissue and circulation is easily interrupted. 
Pressure at the popliteal area will invariably conjest or impoverish 
the end of a long stump. An amputation at the point of election 
on line A-A is much to be preferred. 

No. 6. Failure to remove a little additional tissue at the sides of 
|i long stump, especially in ankle joint amputations will result ill 





A. A. Maries, Artificial Limbs, New York City. 179 


puckerings of the tissue on the sides. These fleshy protuberances 
are easily irritated, they rub against the inner walls of the socket 
of the artificial leg. If pockets are provided the limb is bulky 
to an objectionable degree. 




A — 


Fig. 5 


Fig. 4 


No. 7. It is wise to amputate well away from lacerated parts. 
The importance to save a part of the foot is not great enough to 
justify the retention of doubtful tissue. Stumps reaching to the 
ankle joint, in order to be end-bearing must be covered with healthy 
well-nourished tissue. Better remove the entire foot and produce 
an end-bearing stump after the Symes or Pirogoff methods, line 
A-A, than take a chance on saving a part of the foot when the cover¬ 
ing tissue is questionable. . . 

No. 8. The main object in amputating at the ankle joint is to 
produce an end-bearing stump on which the patient will be able to 
rest his entire weight, and unless this is obtained the amputation 
had better be made at the point of election in the leg. An end¬ 
bearing stump must have a healthy, well-cushioned flap, without 
cicatrix on the parts required to bear weight. In a typical Symes or 
Pirogoff amputation the cicatrix is always laterally across the front 












180 A. A. Maries, Artificial Limbs, New York City. 


a little above the end, but in some modifications, the cicatrix is 
placed across the end directly on the surface where weight is to 
be applied. It is rare that a cicatrized surface becomes strong 
enough to endure weight or pressure. The removal of the foot at 
the ankle, or a part of the foot at the instep, is a mistake if the 
flap must be of such a character as to cause suffering under pressure. 
Better amputate at point of election line A-A. 

No. 9. It is not wise to amputate below an involved part; a long 
stump is not of enough importance to take the risk. Fig. 8 shows 
an amputation at the ankle on account of elephantiasis. It was 



A 


Fig. 6 


Fig. 7 


assumed that, by removing the foot, the disease would disappear 
from the leg, undue importance being given to a long stump. The 
patient suffered for several years, wearing an artificial leg of un¬ 
sightly proportions. Finally, despairing of improvement by nature’s 
operations the leg was amputated at the point of election shown 
by A-A. This party has gotten about conveniently with an artifical 
leg of shapely lines for many years. 

No. 10. In amputating a leg, care should be exercised in re¬ 
moving as much of the fibula as of the tibia. Occasionally in a 
comminuted fracture the ends of the broken bones are but slightly 
trimmed, and if the fracture of the tibia is above that of the 
fibula, the fibula will be left too long. Unfortunately the fibula will 
not hold tissue as well as the tibia and when an artificial leg is 
worn, the end of the fibula becomes denuded. 









A. A. Maries, Artificial Limbs, New York City. 


181 



Fig. 10 


Fig. 11 



















182 A. A. Maries, Artificial Limbs, New York City. 


No. 11. The fibula is sometimes removed in its entirety, since 
it can perform no function whatever in operating an artificial leg, 
its absence is not to be regretted, but its removal leaves a cicatrix 
running the entire length of the external aspect of the stump, which 
is more of an objection than the presence of the bone. 

No. 12. The importance of amputating above an injured or 
lacerated part may be instanced by reciting the case from which 
fig. 12 was sketched. The client was treated for a number of years 
for necrosed tibia. The bone had been scraped, and every effort 



made to grow periosteum and tissue. Years passed with no results. 
The young man met with an accident that crushed the foot of 
the same leg, necessitating amputation. The fact that the necrosed 
tibia had for years been a source of suffering and solicitude was 
entirely ignored, and the amputation was made at the ankle joint. 
An artificial leg was applied and worn for several years, but the 
diseased tibia continued to give trouble, refused to heal and at times 
caused intense pain. Finally the client decided to get rid of the 
annoyance, had the leg amputated above the affected part. In a 
month’s time the stump was healed and an artificial leg was applied, 
the client got about in the most comfortable and advantageous way. 
He has had no trouble since. 

While stumps reaching to the ankle articulation or to the point 
of election are desirable, yet they are not so important as to 
justify doubtful experiments which, may mean years of suffering 
and expense. As a matter of fact, a stump having four or more 






A. A. Maries, Artificial Limbs , New Yorlc City. 183 


inches of tibia is capable of controlling the knee joint of an artificial 
leg and may be said to be long enough. 



Fig. 13 


No. 13. Amputation should not be done at any point below the 
knee when that joint is ankylosed, whether in flexion or extension. 



If there is no reasonable chance that mobility of the knee joint 
can be restored, the amputation should be in the knee articulation. 













184 A. A. Marks, Artificial Limbs, New York City. 


All that is left of the stump below the knee can be of no use in 
operating an artificial leg. The articulation of an artificial knee 
should be on a line with the articulation of the natural. Therefore, 
if the amputation is done below an ankylosed knee there will 
necessarily be a conspicuously elongated thigh if at extension; and 
in case of ankylosis in flexion, the stump will protrude from the 
back of the thigh of the artificial leg. The leg of the trousers 
must therefore be very wide and unsightly in order to cover the 
artificial leg and bent knee. 



No. 14. After amputation through the leg there is a very strong 
tendency for the knee joint to contract, lessening the range of motion. 
To avoid this, the patient should be required to flex and extend the 
knee joint frequently after the stump has healed, and if a slight 
contraction has taken place, a little additional tension should be 
applied by the hands to urge further extension. 

Contracted hamstrings usually relax under the influence of an 
artificial leg, but this change in the knee calls for a corresponding 
change in the artificial leg, all of which can be avoided by a little 
precaution at the right time. 

No. 15. Tissue flaps can be too many,—deep folds of tissue 
require care to keep them clean, they become receptacles for effete 
matter from the skin, and dust working through the clothing, causing 
irritation (fig. 15). Flaps should be as few as possible and should 
provide smooth surfaces to the stump. 







A. A. Maries, Artificial Limbs , New York City. 185 


No. 16. In the amputation of both legs, either above or below 
the knees, it is an error to sacrifice stump (above the point of 
election), in order to have both the same length (fig. 16). It 



Fig. 16 


is possible to have one stump too long and the other too short, 
but this is no reason why one stump should be made short because 
the other has to be. Artificial legs can be adapted to stumps of any 



length and it is a matter of no consequence if there is a difference 
in length, neither should be below the point of election unless it 
can be at the ankle after Symes or Pirogoff methods. 















186 A. A. Maries, Artificial Limbs, New York City. 


No. 17. It was customary in former days to remove the condyles 
of the femur in a knee joint amputation (fig. 17). This practice, 
however, has drifted into disfavor and it will be fortunate when 
all surgeons will look upon it as undesirable. The condyles of 
the femur afford means for holding an artificial leg in place without 
resorting to shoulder suspension. A knee joint stump with the 
condyles present is preferable to a stump tapering from the perineum 
down. The presence of the patilla in the inter-condyllar space is 
desirable provided it is firmly united. A movable patilla is trouble¬ 
some. 



No. 18. If the bones at the knee joint are hopelessly displaced, 
laterally or otherwise, and an amputation is necessary to remove 
a diseased or crushed foot, it had better be in the knee articulation. 
Otherwise the dislocated knee having its functions impaired, will 
fail in operating the knee articulation of an artificial leg and the 
wearer will be at great disadvantage (fig. 18). 

No. 19. Redundancy of tissue on the end of any stump is a 
source of annoyance, and should be avoided. A mass of tissue hang¬ 
ing from the end without muscular control, will flop about, striking 
the sides of the socket of an artificial leg and become troublesome 
(fig. 19). An effort should be made to have only enough tissue to 
cover the end of the stump substantially. 

No. 20. After the stump has healed, it should be bandaged and 
kept so until an artificial leg is applied, otherwise it will take on 
temporary growth (fig. 20). Adipose tissue or edema will form very 





















A. A. Maries, Artificial Limbs, New York City. 187 


quickly and cause complications if not prevented. As soon as an 
artificial leg is applied and worn, atrophy is induced, and a large 



flabby stump will reduce considerably, necessitating either a new 
fitting in the artificial leg or filling up of the old socket,—all of 
which may be avoided by using tight bandages. 



No. 21. An amputation below the knee with excised knee joint 
is unfortunate. The excision of the knee in this case was made 


















188 A. A. Marks, Artificial Limbs, New York City. 


for a pathological condition, and the amputation through the tibia 
was done subsequently on account of traumatism. Why the surgeon 
amputated through the tibia, instead of through the knee is evidence 
of the error of extreme conservatism. 

No. 22. Amputation may be made at the hip joint, with the 
femur disarticulated, or a very little of it left, thus providing no 
stump, or one so short as to be unavailable. A person thus ampu¬ 
tated is not necessarily a subject for crutches the rest of his life. 
The pelvic socket artificial leg recently devised, meets the require¬ 
ments of such cases. 



Fig. 22 


The excision of the knee joint to remove diseased parts and 
uniting the bone of the leg with the femur is in my judgment an 
unwise procedure. This conclusion is based on the experiences of 
several of my clients. Mr. S. of Bluefields, W. Va., had a diseased 
knee. He came to New York with the intention of having his leg 
amputated above the knee. Dr. P. a prominent surgeon took the 
case with the intention of amputating. During the process he 
changed his mind and made an excision of the diseased knee, uniting 
the bones of leg and thigh, believing that he was doing a good service 
for the patient. The patient recovered, returned home but regretted 
that an amputation had not been made, inasmuch as he was very 
much inconvenienced by the presence of the natural leg which was 
three inches shorter than the other and stiff at the knee. He endured 
this inconvenience for about three years, he then submitted to an 
amputation and has since worn an artificial leg to advantage; re- 









A. A. Maries, Artificial Limbs, New York City. 189 


gretting that an amputation had not been made as originally in¬ 
tended. 

Another case, Mr. DeV. of New York City, met with an injury 
in the knee joint resulting in the excision of the join\ The doctor 
united the bones, so the leg was placed at an angle with the thigh. 
Mr. DeV. went about for many years limping perceptibly at every 
step. He finally concluded that he would prefer an artificial leg 
and had an amputation in the thigh. He was not disappointed with 
results, and never regretted the second operation. 



Illustration No. 25 represents a case where conservatism was 
justified but nevertheless resulted in a failure. The subject had his 
left leg badly mangled by a railroad accident. The femur was 
fractured, foot and part of the leg crushed. Amputation was per¬ 
formed about 4" below the knee joint. The fractured femur was 
treated in the usual way with the expectation that the bone would 
unite, but unfortunately a union was not obtained, and several 
efforts to bring about one were unsuccessful. An artificial leg was 
applied but when worn the fractured bones would rub against 
each other and cause irritation and much suffering. The artificial leg 
was provided with a substantial thigh corset for the purpose of 
acting as a splint to the fractured bone. An artificial leg was worn 
for a number of years, but there was much suffering on account of 
the ends of the bone not being held in apposition. After a period 
the subject decided on an amputation, which was made close to the 
















190 A. A. Maries, Artificial Limbs, New York City. 


fracture. An artificial leg was applied and has been used for many 
years with great success. 



Pig. 25 



Fig. 26 


Conservatism in surgery is sometimes carried to a point that 
justifies reproach. The removal of several inches of the tibia, 
then healing the wound, leaving the fibula as the sole support, is 








A. A. Maries, Artificial Limbs , New York City. 191 


one that cannot be too greatly condemned, yet this incredible thing 
is being done in these advanced times (fig. 26). 

To enable the subject to walk, an encasement is required to re¬ 
ceive the leg from the knee down, including a part of the foot. 
The appliance serves fairly well but the client is never able to walk 
and get about as well and as free from annoyance as if the amputa¬ 
tion had been at the point of election. 



Fig. 27 


The removal of the foot in the deformity case shown in fig. 27 
would have been more advisable than its retention, the tarsus being 
united to the fibula. An artificial leg would have been much more 
beneficial and comfortable than the encasement that was worn. 



Fig. 28 


Illustration 28 represents a case of infantile paralysis. The client 
long objected to amputation and carried a very ugly foot for many 
years. He walked on the side of the foot as in Talipes Varus 
and suffered much from corns and ulcers. Despairing of relief, he 
finally submitted to amputation. The leg was removed at the point 
of election and the subject has since worn an artificial leg to advan¬ 
tage and free from suffering. 








192 A. A. Maries, Artificial Limbs, New York City. 


Finally, I wish to take this opportunity to express my opinion, 
based on repeated observation, that the resection of the Astragalus 
and Oscalcis, and the union of the Cuboid and Scaphoid with the 
tibia and fibula (fig. 26) produces as bad conditions as exist in 
talipes equinus and that the Wladimiroff-Mikulicz operation, there¬ 
fore, cannot be favorably considered by the orthopidist or prothesist. 

No person can stand or walk any length of time on the limited 
surface of the ball of the foot; that part will soon develop corns 
or ulcers. It must be remembered, too, that the operation elongates 
the leg two or more inches, necessitating an appliance for the 



Fig. 29 

opposite foot to bring about an equality in the lengths of both. The 
expense of two appliances, one for the foot that has been operated 
on, and the other for the opposite, is much more than the cost of 
an artificial leg. 

It is better to amputate at the ankle, if a heel flap can be 
obtained, and, if not, at the point of election in the leg. The 
patient will fare much better with an artificial leg. 

An artificial leg cannot be applied too soon after the stump is 
healed in traumatic cases. Waiting entails a loss of time, and 
permits a stump to become flabby and enervated from inactivity. 

The presence of a stubborn sinus on the end of the stump is 
not necessarily a reason why an artificial leg should not be applied. 
As a matter of fact, the wearing of an artificial leg puts no pressure 
on the end of the stump, which (except in disarticulations) practi¬ 
cally hangs in space. In wearing an artificial leg, the stump is 













A. A. MariesArtificial Limbs, New York City. 193 


stimulated by the work it is performing, the circulation becomes 
more active and in a great many cases a stubborn sinus is induced 
to heal substantially and permanently. 

Many deformity and paralytic cases where surgeons could greatly 
improve matters are presented in other parts of this book. 



194 A. A. Marks, Artificial Limbs , New York City. 


CODE 

FOR ORDERING ARTIFICIAL LEGS OR ARMS BY CABLE OF 
A. A. MARKS, 702 BROADWAY, NEW YORK, N. Y. 

Copyright 1923 by Geo. E. Marks. 

A message may be coded and cabled provided it consists of words 
that are pronounceable and do not contain more than ten letters each. 

This code is based on consonants. Vowels a, e, i, o, u, w, y, are only 
used to form words. 

Two letters are used to represent a sentence for example: tfz, 
means Right leg amputated below knee; Fc means For a man; Ds 
means Make Strong. These three couplets put togther Bzfcds do not 
make a word that is pronounceable. By introducing vowels (u, a and 
e for example), we turn the three couplets into the word Buzfacdes, 
which is pronounceable and which means by the Marks Code, Right leg 
amputated below knee, for a man, to be made strong. Another ex¬ 
ample : Fh means, Distance from crotch to floor; Tk means, 30 A 
inches; Fhtk is not pronounceable, but by inserting vowels (o and i, 
for example), it becomes Fohtik which is pronounceable and means, 
Distance from crotch to floor is 30% inches. 

The selection of vowels is purely optional; they are only used to 
make words pronounceable and it is immaterial what vowels are used 
or where they are placed as long as the word is made a pronounceable 
one of not more than ten letters. 


INSTRUCTIONS 

First —Take all the measurements and diagrams and answer all the 
questions called for on Marks’ order sheet. The same as if you in¬ 
tended to order by mail. 

Second —Prepare the Code Message by selecting the couplets in 
* Code for Specifications,” under Section 1; thereby indicating the type 
of artificial limb needed. 

Third —Select the couplets indicating only the essential points on 
the sound and amputated limbs where measurements have been taken. 

Fourth —To each of the above couplets add the couplet that repre¬ 
sents the measurement in inches. 

You now have a string of consonants. Introduce any of the vowels 
between the consonants, anywhere, so they will form pronounceable 
words of not more than ten letters each (including the vowels). Attach 
your signature and forward by cable. The message can be addressed, 
“ Artificial ” New York, which is our Code address. 

The complete measurements and diagrams you have taken should be 
sent immediately by mail together with a draft covering the cost of 
the limb. Immediately upon receipt of the cable message we will start 
the construction of the limb you require, and by the time it is finished 
the measurements and diagrams which you will have forwarded by mail 
will reach us. We will then make comparison and if everything is to 
our satisfaction, the limb will be forwarded immediately. 

We want the measurements, diagrams and answers to questions for 
record purposes and future reference. 

Note that in the message coded we do not require all the measure¬ 
ments called for on the measuring sheet; only those that can readily be 
seen as essential. 



A. A. Maries, Artificial Limbs, New York City. 195 


Artificial limbs for partial feet and partial band amputations and 
those that are required to meet unusual conditions should not be 
ordered by cable. Diagrams in such cases are necessary and they must 
be forwarded by mail. 

After the Coded Message is prepared, it will be well to translate 
or de-code it, thus you can prove your work. 

Cable Address—ARTIFICIAL, NEW YORK. 

Mail Address—A. A. MARKS, 702 BROADWAY, 

New York, N. Y., U. S. A. 



196 A. A. Maries, Artificial Limbs, New York City . 


SECTION I 

CODE FOR SPECIFICATIONS 

Bb — Right hip joint amputation, no tissue protruding, amputated 
surface even with pelvis. 

Bd — Left hip joint amputation, no tissue protruding, amputated sur¬ 
face even with the pelvis. 

Be — Right hip joint amputation, tissue or muscles stump hanging 
down from the pelvis. 

Bf — Left hip joint amputation, tissue or muscle stump hanging down 
from the pelvis. 

Bg — Right leg amputated in the thigh below the hip and above the 
knee. 

Bh — Left leg amputated in the thigh below the hip and above the 
knee. 

Bk — Right leg amputated in the knee joint, condyles removed, end of 
the stump capable of bearing weight. 

B1 — Right leg amputated in the knee joint, condyles present, end of 
the stump capable of bearing weight. 

Bm — Left leg amputated in the knee joint, condyles removed, end of 
stump capable of bearing weight. 

Bn — Left leg amputated in the knee joint, condyles present, end of 
stump capable of bearing weight. 

Bp — Right leg amputated in the knee joint, condyles removed, end of 
stump not capable of bearing weight. 

Br — Right leg amputated in the knee joint, condyles present, end of 
stump not capable of bearing weight. 

Bs — Left leg amputated in the knee joint, condyles removed, end of 
stump not capable of bearing weight. 

Bt — Left leg amputated in the knee joint, condyles present, end of 
stump not capable of bearing weight. 

Bv — Right leg amputated below the knee, knee bent, weight taken 
on the bent knee, knee-bearing leg required. 

Bx — Left leg amputated below the knee, knee bent, weight taken 
on the bent knee, knee-bearing leg required. 

Bz — Right leg amputated below the knee and above the ankle. 

Cb — Left leg amputated below the knee and above the ankle. 

Cc — Right foot amputated at the ankle joint, end of stump capable 
of bearing weight. 

Cd — Right foot amputated at the ankle joint, end of stump not 
capable of bearing weight. 

Cf — Left foot amputated at the ankle joint, end of stump capable 
of bearing weight. 

Cg — Left foot amputated at the ankle joint, end of stump not 
capable of bearing weight. 

Ch — Both legs amputated. 

Ck — Artificial leg to have a rubber foot without ankle joint. 

Cl — Artificial leg to have ankle joint. 

Cm — Right arm amputated at the shoulder joint. No stump pro¬ 
truding. 

Cn — Right arm amputated at the shoulder joint, a tissue or muscle 
stump protruding. 

Cp — Left arm amputated at the shoulder joint, no stump protruding. 

Cr — Left arm amputated at the shoulder joint, a tissue or muscle 
stump protruding. 

Cs — Right arm amputated below the shoulder and above the elbow. 



A. A. Maries, Artificial Limbs, New York City. 197 


Ct — Left arm amputated below the shoulder and above the elbow. 

Cv — Right arm amputated in the elbow joint. 

Cx — Left arm amputated in the elbow joint. 

Cz — Right arm amputated below the elbow and above the wrist. 

Db — Left arm amputated below the elbow and above the wrist. 

Dc — Right hand amputated at the wrist joint, styloids removed, pro¬ 
ducing a tapering stump. 

Dd — Right hand amputated at the wrist joint, styloids present, 
stump larger at the end than above. 

Df — Left hand amputated at the wrist joint, styloids removed, pro¬ 
ducing a tapering stump. 

Dg — Left hand amputated at the wrist joint, styloids present, stump 
larger at the end than above. 

Dh — Both arms amputated. 

Dk — Artificial arm to go only to the elbow, no joints or upper part 
required. 

D1 — Size of glove to be worn on the artificial hand. 

Dm — The artificial arm to have rotation at wrist. 

Dn — The artificial arm to have flexion and extension at wrist. 

Dp — The artificial arm is to have rotation, flexion and extension at 

wrist 

Dr — The rubber hand to be permanently attached to the forearm 
admitting of no motion whatever. 

Ds — Make artificial limb very strong. 

Dt — Make artificial limb very light. 

Dv — Make artificial limb from measurements and forward imme¬ 
diately. 

Dx — Construct the limb from measurements but do not ship until 
you receive the measurements forwarded today, and when you 
receive them verify the code measurements and prove the work 
before shipping. 

Dz — The artificial limb is to be worn by a boy. 

Fb — The artificial limb is to be worn by a girl. 

Fc — The artificial limb is to be worn by a man. 

Fd — The artificial limb is to be worn by a woman. 

Ff — The artificial limb is to be worn by an old man. 

Fg — The artificial limb is to be worn by an old woman. 



198 A. A. Maries.Artificial Limbs, New York City. 


SECTION II 

CODE FOR PLACES ON THE LIMB AND STUMP WHERE 
MEASUREMENTS ARE TAKEN 

Fh — Distance from crotch to floor. 

Fk — Distance from top of knee to floor, bent at right angle. 

FI — Length of the foot. 

Fm — Circumference of the thigh of sound leg on line with the crotch. 
Fn — Circumference of the thigh of sound leg midway between the 
crotch and knee. 

Fp — Circumference of knee joint of sound leg. 

Fr — Circumference of calf sound leg. 

Fs — Circumference of ankle just above the joint of sound leg. 

Ft — Circumference of heel and instep. 

Fv — Circumference of instep. 

Fx — Circumference of the foot at the base of the toes or ball. 

Fz — Distance from crotch to end of stump. 

Gb — Distance from end of stump to the floor. 

Gc — Distance from bent knee to floor. Required only when knee¬ 
bearing leg is wanted. 

Gd — Distance from popliteal space to end of stump knee bent to 
right angle. 

Gf — Circumference of amputated leg on line with crotch. 

Gg — Circumference of amputated leg four inches below crotch. 

Gh — Circumference of amputated leg eight inches below crotch. 

Gk — Circumference of amputated leg twelve inches below crotch. 

G1 — Circumference of amputated leg around the knee joint. 

Gm — Lateral diameter of condyles or knee joint, amputated side. 

Gn — Circumference of stump just below knee cap. 

Gp — Circumference of stump four inches below knee cap. 

Gr — Circumference of stump eight inches below knee cap. 

Gs — Circumference of stump twelve inches below knee cap. 

Gt — Circumference of stump sixteen inches below knee cap. 

Gv — Circumference of stump at the ankle joint. 

Gx — Circumference of waist just above the hips. 

Gz — Distance of point of shoulder to tip of elbow sound arm. 

Hb — Distance from tip of elbow to wrist sound arm. 

He — Distance from wrist to end of thumb. 

Hd — Circumference of sound arm on line with axilla. 

Hf — Circumference of sound arm midway between axilla and elbow. 
Hg — Circumference of elbow joint sound arm. 

Hh — Circumference of wrist sound arm. 

Hk — Circumference of hand at base of fingers under the thumb. 

HI — Distance from point of shoulder to end of stump. 

Hm— Distance from point of shoulder to tip of elbow amputated side. 
Hn — Distance from tip of elbow to end of stump. 

Hp — Distance from bend of elbow to end of stump. 

Hr — Circumference of arm on line with axilla amputated side. 

Hs — Circumference of arm four inches below axilla amputated side. 
Ht — Circumference of arm eight inches below axilla amputated side. 
Hv — Circumference of elbow joint amputated side. 

Hx — Circumference of stump just below elbow. 

Hz — Circumference of stump four inches below elbow. 

Kb — Circum*ference of stump eight inches below elbow. 

Kc — Circumference of stump twelve inches below elbow. 

Kd — Circumference of stump about the end. 

Kf — Circumference of chest. 



A. A. Maries, Artificial Limbs , New York City. 199 


Kp — 1 
Kr — 1 % 

Ks — 2 


SECTION III 

CODE FOR MEASUREMENTS 

Nk — 13% 

N1 — 14 
Nm — 14% 


Kt — 

2 % 

Kv — 

3 

Kx — 

3% 

Kz — 

3 % 

Lb — 

3% 

Lc — 

4 

Ld — 

4% 

Lf — 

4y 2 

Lg - 

4% 

Lh — 

5 

Lk — 

5% 

LI — 

5% 

Lm *— 

5% 

Ln — 

6 

Lp - 

6% 

Lr — 

6% 

Ls — 

6% 

Lt — 

7 

Lv — 

7% 

Lx — 

7% 

Lz — 

7% 

Mb — 

8 

Me — 

8% 

Md — 

8% 

Mf — 

8% 

Mg — 

9 

Mh — 

9% 

Mk — 

9% 

Ml — 

9% 

Mm — 

10 

Mn — 

10% 

Mp — 

ioy 2 

Mr — 

10% 

Ms — 

n 

Mt — 

n% 

Mv — 

ny 2 

Mx — 

n% 

Mz — 

12 

Nb — 

12% 

Nc — 

12% 

Nd — 

12% 

Nf — 

13 

Ng — 

13% 

Nh — 

13% 


Nn 

— 14% 

Np 

— 14% 

Nr 

— 15 

Ns 

— 15% 

Nt 

— 15% 

Nv 

— 15% 

Nx 

— 16 

Nz 

— 16% 

Pb 

— 16% 

Pc 

— 16% 

Pd 

— 17 

Pf 

— 17% 

Pg 

— 17% 

Ph 

— 17% 

Pk 

— 18 

PI 

— 18% 

Pm 

— 18% 

Pn 

— 18% 

Pp 

— 19 

Pr 

— 19% 

Ps 

— 19% 

Pt 

— 19% 

Pv 

— 20 

Px 

— 20% 

Pz 

— 20% 

Rb 

— 20% 

Re 

— 21 

Rd 

— 21% 

Rf 

— 21% 

Rg 

— 2134 

Rh 

— 22 

Rk 

— 22% 

R1 

— 22% 

Rm 

— 22% 

Rn 

— 23 

Rp 

— 23% 

Rr 

— 23% 

Rs 

— 233/ 4 

Rt 

— 24 

Rv 

— 24% 

Rx 

— 24% 

Rz 

— 24% 

Sb 

— 25 

Sc 

- 25% 


Sd 

— 25% 

Sf 

— 2534 

Sg 

— 26 

Sh 

— 26% 

Sk 

— 26% 

SI 

— 26«4 

Sm 

— 27 

Sn 

— 27% 

Sp 

— 27% 

Sr 

— 2734 

Ss 

— 28 

St 

— 28% 

Sv 

— 28% 

Sx 

— 28% 

Sz 

— 29 

Tb 

— 29% 

Tc 

— 29% 

Td 

— 2934 

Tf 

— 30 

Tg 

— 30% 

Th 

— 30% 

Tk 

— 3034 

T1 

— 31 

Tm 

— 31% 

Tn 

— 31% 

Tp 

— 31% 

Tr 

— 32 

Ts 

— 32% 

Tt 

— 32% 

Tv 

— 32% 

Tx 

— 33 

Tz 

— 33% 

Vb 

— 33% 

Vc 

— 3334 

Vd 

— 34 

Vf 

— 34% 

Vg 

— 35 

Vh 

— 35% 

Vk 

— 36 

VI 

— 36% 

Vm 

— 37 

Vn 

— 38 

Vp 

— 39 

Vr 

— 40 

Vs 

— 41 

Vt 

— 42 



200 A. A. Maries , Artificial Limbs, New York City. 


EXAMPLE 


CODE 
Cb — 
Ff — 
Ck — 
Dt — 
Dv — 
FhTn — 
FkRh — 
FIMm. — 
FmRl — 
FnPp — 
FpNg — 
FrNn — 
FsMk — 
FtNf — 
FvMd — 
FxMg — 
FzSd — 
GbLn — 
GdMs — 
GfPv — 
GgNx — 
GhNr — 
GkNc — 

GINf — 
GnMz — 
GpMm — 

GrMk — 


Artificial left leg amputation between knee and ankle. 

To be worn by an elderly man. 

The leg to have a rubber foot with rigid ankle. 

To be of light construction. 

To be made as quickly as possible and shipped. 

Sound leg from crotch to floor 31% inches. 

Sound leg from top of knee to floor 22 inches. 

Length of foot 10 inches. 

Circumference of thigh at body or crotcSh 22% inches. 
Circumference of midthigh 19 inches. 

Circumference of knee joint, 13% inches. 

Circumference of calf 14% inches. 

Circumference of ankle 9% inches. 

Circumference of heel and instep 13 inches. 

Circumference of instep 8% inches. 

Circumference of ball of foot 9 inches. 

Distance from crotch to end of stump 25% inches. 

Distance from end of stump to floor 6 inches. 

Distance from popliteal space to end of stump 11 inches. 
Circumference amputated leg close to crotch 20 inches. 
Circumference amputated leg 4 inches below crotch 16 inches. 
Circumference amputated leg 8 inches below crotch 15 inches. 
Circumference amputated leg 12 inches* below crotch 12% 
inches. 

Circumference amputated leg knee cap 13 inches. 
Circumference amputated leg just below knee cap 12 inches. 
Circumference amputated leg 4 inches below knee cap 10 
inches. 

Circumference amputated leg 8 inches below knee cap 9% 
inches. 


Code couplets representing the above are as follows: 

Cb Ff Ck Dt Dv Fh Tn Fk Rh FI Mm Fm R1 Fn Pp Fp Ng 
Fr Nn Fs Mk Ft Nf Fv Md Fx Mg Fz Sd Gb Ln Gd Ms Gf Pv 
Gg Nx Gh Nr Gk Nc G1 Nf Gn Mz Gp Mm Gr Mk. 

Introducing vowels and separating into words that can be pro¬ 
nounced and that have ten or less letters in each, the cable message— 
with address—may be as follows: 

Artificial, New York 

Cabiffack Dotadiv Fahaten Fakirhofel Mimifamrol Funappif 
Pingferen Nafsemkof Tonfafvim Dufixmag Fozsadgib Lingdoms 
Gofpovig Gunexghon Ragknic Glenfagon Mazgopam Migramik. 

Signed 



CHAPTER XVII 


HANDS AND ARMS, NATURAL COMPARED WITH 
ARTIFICIAL 

History. —Artificial hand and arm construction has advanced 
with that of artificial legs. The modern arm is calculated for 
general purposes, the ancient had only one object in its design. 
M. Sergius (167 B. C.), referred to by Pliny, wore an artificial 
arm, with which he held his shield while in battle, and released 
Cremona from siege. The artificial arm made for a celebrated 
tenor of the sixteenth century was used successfully in his his¬ 
trionic gesticulations; the arm of the celebrated Surgeon Pare, 
as well as the productions of Lorrain, Sebastian, Bailiff, Verduin, 
Serre, Wilson, and De Graef, and all the early makers, had but 
few functions to perform. 

There is a strong inclination to the belief that artificial arm 
construction has retrograded, and that those of modern times 
are not as useful as those of the early masters. Visitors to 
European museums, where many of the archaic substitutes are 
exhibited, are impressed by the profuse and extravagant labels 
and catalogues, ascribing to the wearers miraculous deeds of 
valor, performed in battle. 

We are in position to state that historic substitutes were useless 
beyond the specific purposes for which they were designed, and 
were greatly inferior to those of modern construction. The 
ancient arm weighed from twenty to thirty pounds, was made 
of steel, copper and leather, and could be worn only on a long 
and powerful stump. The modern arm weighs from one to two 
and a half pounds, is made of rubber, wood, rawhide, leather, 
and metal, and can be worn on short, enervated, and nervous 
stumps to advantage. They have a range of utility infinitely 
greater than those used by warriors centuries ago. 

The need for artificial arms has never been as great as now. 
The incentive to invent and improve is always responsive to 
demand. Want begets supply, and competition is the stimulus 
that carries improvements close to the goal of perfection. 

The Demand Greater. —The demand has increased in direct 
proportion to the utilization of machinery in the industries and 
to the expansion of methods for rapid transportation. As the 
mileage of railroads increases, the mutilation of the human body 
is more frequent. The electric trolley has maimed more than 
the horse-cars of a decade ago. The mowing machine and the 
reaper have cut off more limbs than the scythe or cradle, dynamite 
has mutilated the human body more than the black powder of 

201 


202 A. A. Marks, Artificial Limbs, New York City. 


former days. These agencies, necessary for quick results, are 
dreadful implements of death and mutilation. 

Simplicity. —In recent years the tendency of the arm manu¬ 
facturer has been to simplify construction; the earlier devices 
were complicated, burdensome to carry, expensive to maintain, 
and unreliable. Ho one will now tolerate a clumsy, heavy, noisy, 
complicated, and unwieldly arm; neat adaptation to the stump, 
lightness and naturalness of appearance, durability and utility, 
are the only essentials that will satisfy. 

What an Artificial Arm Must Do—The artificial arm must 
conceal the loss, protect the stump, restore a natural appearance 
to the dismembered side, provide a medium that will force the 
stump into healthful activity, and, in the way of utility, it 
must assist the opposite hand, carry articles of moderate weight, 
and, if the stump is powerful, the hand must be capable of cutting 
food on the plate and carrying the morsels to the mouth. The 
modern arm is capable of all this, and still more. A pen can be 
placed between the finger and thumb, and, after a little practice, 
the wearer will learn to write quickly and legibly. Implements 
capable of specific functions can be held in the hand or in the 
socket. A ring will help the farmer in guiding the handles of 
his farming tools; it will assist the blacksmith in wielding the 
sledge. A pair of pincers is capable of holding the work of a 
jeweler, a claw hook, a clevis, a hand vise; in fact, a great variety 
of implements have their distinct uses. While these attachments 
are capable of a large range of adaptation, there is a limit beyond 
which art and science cannot go. These operations of the natural 
hand that depend on the brain for their functions cannot possibly 
be performed by mechanical devices. 

The Natural Hand a Marvel. —The intelligence with which 
the natural arm is endowed is the result of the system by which 
mental force is carried from the brain to the distant fingers. The 
human hand and arm are marvels of mechanism, their combina¬ 
tions of motions are almost limitless, their functions vast, their 
capabilities beyond comprehension. The motion of the shoulder is 
circumrotary; those of the elbow, flexion and extension; those of 
the wrist, rotary, circumrotary, flexion, and extension, and the 
fingers are capable of a range of accommodation almost limitless. 
Every joint is connected by powerful sinews, tendons, muscles, 
nerves, and blood vessels, which perform their work in conveying 
the commands of the mind to the most distant parts, and in com¬ 
pelling an instantaneous obedience. The hand that is capable of 
placing the delicate works of a watch is capable of placing the 
stones of a cathedral. And yet the human arm is but a machine, 
useless by itself. 

The Brain. —The brain is the vis-viva that renders it capable 
of its wonderful work. If the medium that conveys the wishes 
of the mind to the arm be destroyed, if the co-ordination be 
impaired, the natural arm ceases to be any more valuable than 
an artificial one of the crudest type. 



A. A. Marks, Artificial Limbs, New York City. 203 


An artificial arm, no matter how ingeniously it may be con¬ 
structed, pales into insignificance when its functions are com¬ 
pared with those of the healthy arm nature has given us. Never¬ 
theless, it is far more useful than the natural arm that has become 
palsied. 

Self-Repairing. —The natural arm has other endowments, aside 
from its responsiveness to the will. The power of repairing itself 
is one of its mysterious attributes. The bearing surfaces of the 
bones would grind away, the tendons would stretch and become 
inert if this process were not in constant operation. If a muscle 
becomes lacerated, or a tendon detached, or a bone broken, the 
work of reparation soon restores the injured part to its normal 
relations. Every drop of blood that flows through the arteries 
carries new material to replace the waste, and every drop of blood 
that flows through the veins carries away the particles that have 
become diseased and detached. In old age, when the human repair 
shop becomes disorganized, the entire physical mechanism breaks 
down, and the end soon follows. 

Sense of Touch. —Another great and important endowment of 
the natural hand is the sense of touch. This sense is susceptible 
of cultivation. The contact of the fingers will convey the infor¬ 
mation that the substance is soft or hard, liquid or solid, dry or 
wet. The blind man is capable of reading by the tips of his 
fingers. When we place our hands in our pockets, we know by 
this sense whether we take hold of a key or a jackknife, a hand¬ 
kerchief or a lead pencil. The moment we touch the object we 
know what motions the fingers are to make and the strength 
required to put that object within our grasp. 

An artificial hand is absolutely devoid of sensation. When we 
call to mind the fact that an artificial arm, made with joints, 
springs, and cords cannot be endowed with mental sympathy or 
with the power of repairing itself, or with the sensation of touch, 
we must become reconciled to the fact that it is necessarily of 
limited capacity. 

Stories Misleading.— We are frequently amused by reading 
newspaper articles on artificial arms, made by forgotten mechanics, 
“that are fully as good as natural arms.” We frequently have 
to listen to the narration of some magical performances of men 
who wear artificial arms. We recall an article that appeared in a 
Canadian newspaper, of a woman who had a pair of arms adjusted 
to her person, supplementary to her natural ones. She became 
so dexterous in manipulating them that when in a public con¬ 
veyance she would hold a book in her artificial hands, and, while 
apparently reading, would, with her natural hands, pick the 
pockets of those who sat next to her. 

We have also read the story of a politician who lost his arm m 
the Civil War, and who had an ingenious artificial one applied 
that enabled him to shuffle a deck of cards, pick up a glass of beer 
and carry it in his mouth; and, on one occasion, when m a bar¬ 
room brawl, he liberated a spring, and the arm immediately began 



204 A. A. Marks, Artificial Limbs, New York City. 


its pugilistic movements, with more vigor and more deadly results 
than possible for the natural arm. Quite recently a New York 
paper gave a page to the description of an artificial arm, made 
by a German prothesist, that incases the undeveloped arm of the 
Emperor of Germany; the description of the arm and the func¬ 
tions it was capable of performing were extremely absurd and 
amusing to those acquainted with prothesis, but to laymen unac¬ 
quainted with the subject, there was a strain of plausibility that 
must have made some persons believe that at last a mechanic is 
on the earth who is as skillful as Divinity Himself. 




CHAPTER XVIII 

IS IT PROFITABLE TO BUY AX ARTIFICIAL ARM? 


If I procure an artificial arm, will I make any practical use of 
it? If I do not, can it in any way contribute to my physical or 
mental comfort? Is the risk worth taking? 

These are the questions that have to be answered. They weigh 
heavily upon the minds of those who find it necessary to exercise 
economy in their purchases. 

Whether male or female, rich or poor, the feasibility of substi¬ 
tuting a member that has been lost must be thoughtfully con¬ 
sidered. 

Let us first take up the question of ornamentation. 

Ornamentation. —That a person will make a better appearance 
with an artificial arm properly dressed than with an empty sleeve. 



is obvious. To conceal any physical defect is a natural aim. 
There is nothing so distressing, especially to a sensitive person, 
as the exhibition of any imperfection in his anatomy. 

The glass eye is worn for no other purpose than ornament. 
It fills a sightless socket and conveys the impression that the 
natural eye is there; it does not restore vision nor fulfill the 
optical functions, yet thousands of them are worn with a feeling 
that they are indispensable. They certainly look well, and are 
to be preferred to the cloth patch frequently seen. The man with 
a hunched back pays his tailor very dearly for the skillful adjust¬ 
ment of pads in his coat, so as to minimize the visibility of his 
deformity. 

Any deficiency of the body that becomes conspicuous will attract 
attention and invite comment and sympathy. No person who 
maintains his self-respect, no matter what his disability may be, 
cares to be constantly reminded of) it, and the commiseration of 
others, above all things, is the most abhorrent. To be frequently 
asked: “ How did it happen ? ” “ Did you lose your arm in the 

war?” “ Were you in a railroad collision?” or to have such 
utterances as: “Poor, unfortunate man!” “How he must have 

205 



206 A. A. Marks , Artificial Limbs, New York City. 


suffered! ” “ What a terrible loss! ” whispered within your hear¬ 
ing, may, for a while, be accepted in good part, but their repeti¬ 
tion soon becomes annoying and odious. 

An artificial arm will conceal the loss, restore a natural appear¬ 
ance to the person, avoid observation and comment, and after it 
has been worn a short time will become companionable and neces¬ 
sary to the wearer’s mental comfort. 

The Kussian prince, Galitzin, obtained an artificial arm of us 
to cover a deformed and undeveloped member, the conspicuousness 
of which had given him much solicitude. He was elated over the 
results and pronounced the purchase a most satisfactory one, 
fully paying him for his long journey from Moscow to New York. 

Miss Julia Shay Lindsay, of Polk County, Minn., struggled 
with this subject for some time, and finally ordered an artificial 



hand. The results that followed are clearly set forth in a letter 
recently addressed to us: “ It is over five months since I received 
the artificial hand which my doctor ordered for me. I am very 
much pleased with it. No one can tell the artificial hand from 
the natural one. In this, it is a source of great comfort.” 

A. T. Basden, of Hamilton, Bermuda, who had both of his 
arms amputated between the elbows and wrists, wrote recently, as 
follows: “ The artificial arms you sent me fit acceptably. They 
meet with my expectations. I find them helpful and especially 
valuable, as they hide my misfortune. Prior to the application 
of the arms, I suffered considerably with my stumps, but since 
wearing them the pain has entirely ceased.” 

Hygiene. —This part of the subject, considering the importance 
it bears to the general health and welfare of the individual, has 
not been sufficiently emphasized. With much pleasure we quote 



A . A. Maries, Artificial Limbs, New York City. 207 


from Dr. Schenck, of Cincinnati, Ohio: “Pain is the cry of a 
hungry nerve for food. 

“ When a part of the body becomes inactive, as is the case with 
the stump of an amputated arm, the inability to receive the 
necessary activity on account of the abbreviation of its length, 
permits the stump and muscles to fall into a quiescent condition; 
in consequence there occurs a stagnation in the venous system, 
which depends entirely upon muscular activity for the return of 
the venous blood to the lungs for aeration, from whence it is again 
pumped by the heart to the different parts of the body, in order to 
carry nourishment and oxygen to the tissues so that the normal 
metabolism can occur, and thus produce the physiological tone 
required for a healthy individual. 

“ As such, an abbreviated member, unassisted, cannot contribute 
the necessary energy for its welfare; because of the above-ex¬ 
plained pathological condition, it must suffer and lose its normal 
tone and indirectly, as in diseased organs of the body, affect the 
general economy in a more or less degree, depending upon the 
temperament of the individual. 

“ So that, from the hygienic view, an artificial arm will cause 
the defective part to functionate, causing activity of the remain¬ 
ing muscles, and thus stimulate its circulation, giving to the 
part the required nourishment and preventing the accumulation 
of effete material and dismissing a conspicuous deformity, which, 
no matter how indifferent the unfortunate assumes to be, has 
some influence upon his nervous system, all of which, being 
improved, is conducive to promote a healthy tone to the whole 
body.” 

It is not an infrequent occurrence for a person to complain of 
peculiar, dull aches, or nerve twitchings, or sharp, stinging darts 
of pain in his stump. Investigation will disclose the fact that 
these are nervous disturbances, due to muscular inactivity, and, as 
soon as stumps are forced to do something, the distress will almost 
invariably disappear. 

Dr. Cook, United States Examining Surgeon, puts this phase 
of the subject in an interesting and unique light: 

“ When a limb has been amputated, the stump, or remaining 
portion, takes on queer antics and assumes conditions that are 
in accordance with well-known physiological and psychological 
laws. 

“For instance, it is no uncommon occurrence for a man who 
has lost a part of his leg by amputation to have a severe pain in 
the heel, foot, or toe of the lost member, or for those who have 
lost parts of their arms to have excruciating pains in the wrists, 
hands, or fingers of the amputated parts. To those unaccustomed 
to these nerve complications this may appear absurd, but they 
are facts well known to neurologists. 

“ It would seem that the stump, or part remaining after ampu¬ 
tation, either resented the indignity that it had been subjected to, 
or else made its sorrow for its loss manifested by these means. 



208 A. A. Marls ,, Artificial Limbs, New Yorl City. 


“ The man who allows an amputated arm to hang indolently by 
his side makes a mistake. The muscles above the stump shrink 
and waste away for a lack of nourishment, and the nerves become 
irritable and neuralgic. An undisputed physiological law is that 
‘ action increases strength,’ and the reverse is just as true, that 
inaction produces weakness. 

“ Place an artificial arm on the idle stump and it at once begins 
to get a better circulation of the blood, the muscles begin to 
develop, and the nerves have something to think about besides 
their terminals.” 

Dr. L. G. Armstrong, of Boscobel, Wis., in emphasizing the 
importance to persons who have had legs or arms amputated, to 
procure artificial ones, presents in a forcible way the penalty that 
must be paid if a stump is permitted to become indolent: 

“ Artificial limbs have added much to afflicted humanity in the 
way of happiness and comfort. 

“ Physiology teaches plainly that the want of use of any part 
begets weakness. Atrophy of the muscles is sure to follow, which 
is the legitimate consequence of the neglect. To prevent this, 
begin using the stump as soon as it is thoroughly healed, when 
the adhesions are perfect, save atrophy, and put the muscles to 
their new use. Neuralgia of the stump is always sure to follow, 
or it may even antedate the withering away of the muscles for 
the want of proper use. Get a well-made, perfectly fitting limb, 
and you have at once removed the cause of nervous disturbances 
and the mental shock. You have added much to the person’s 
ability to earn a livelihood. My experience is that artificial 
limbs are soon accepted, and soon used to advantage, and so much 
so that money would not induce the wearers to do without them. 
My advice is to get an artificial limb at the first practical moment, 
after the stump is perfectly healed.” 

Dr. T. P. Smith, of Tacoma, Wash., says: “ During the last 
fourteen years you have fitted a great number of my patients 
with artificial limbs, and they have all given entire satisfaction. 
The proposition that a limb, whether a stump or whole, needs 
and is benefited by motion, is so self-evident as not to call for 
discussion; a stump becomes useless without it. 

“ I am in the habit of using motion in all cases of fracture, 
as well as in all cases of amputation, to prevent atrophy of the 
muscles, and stiffening of the joints, and as soon as a stump, 
after amputation, is healed, I insist on applying an artificial 
limb. Until the limb comes, I insist on the patient doing the 
best he can toward exercising and using his stump. After the 
limb is adjusted he will naturally use it, and that will prevent the 
stump from becoming flabby and fat. 

“ In conclusion, I will say that I know of no way to retain the 
use of a leg or arm, except it be early fitted with an artificial 
limb, and the sooner it is done the better. In spite of bandaging, 
and such motion and exercise as patients can give their stumps, 
they become large and flabby.” 



A. A. Marks, Artificial Limbs, New York City. 209 


Dr. Geo. E. Powell, La Crosse, Wis., writes: “ We have had your 
artificial limbs for twenty years and consider them the best made. 
We have never applied one that did not give satisfaction. Many 
arm stumps that were soft and doughy to the feel, became strik¬ 
ingly firm and vigorous with the use of artificial arms.” 

Dr. Chas. F. Noe, of Amana, la., states: “I wish to say that in 
my experience a well-fitting artificial arm exercises a beneficial 
influence on the stump, due to the stimulus given to circulation 
and nutrition, and thus preventing stagnation from disuse.” 

Dr. J. H. Sieling, of York, Pa., says: “ The arm that you sent 
me recently has done more work than my fondest hopes expected; 
it has not only had a helping influence on my patient’s stump, 
but adds greatly to his appearance. He is able to execute some 
very helpful acts with the elegant equipment; he eats, by its help, 
very artistically indeed. I am only too glad to add a word of 
commendation whenever opportunity offers.” 

Carl M. Person, of Webster County, Neb., states: “ I will write 
to you and let you know that my arm is all right. I have worn 
it every day since I got it, and have never been chafed or ex¬ 
perienced any inconvenience. The arm is useful as well as orna¬ 
mental. I find that the exercise my stump receives from it 
prevents those dull pains that I suffered from for so long a time, 
and I value it for this reason far more than the money it cost.” 

William F. Starner, of Carroll County, Md., writes: “I have 
been wearing one of your artificial arms for about three years, and 
am well pleased with it. I can do most any kind of work. The 
arm exercises my stump, and keeps it in a more pleasant condi- 

tion.” . , , 

The utility to be derived from an artificial arm depends very 
largely upon the length of the stump, the strength of the 
muscles, and the aptitude of the wearer. The stump must be 
long in order to provide a lever with which to control the hand 
and forearm in lifting such articles as may be placed in the hand. 
Although the artificial arm is very light, the power to elevate it 
must come from the muscles in the arm and shoulder, and when 
the stump is very short, and the muscles weak, the utility of an 
artificial arm is lessened. But, notwithstanding these conditions, 
the artificial arm should be worn on the shortest of stumps. There 
are persons who have more aptitude than others, and perform feats 
under adverse conditions that are marvelous; some with short 
stumps do more than others with long ones. It is safe to say, how¬ 
ever, that any person, no matter how short a stump he may have, 
may, with patience and application, learn to operate an artificial 
arm’ and derive a reasonable compensation from it. Ambition, 
application, and thoughtful effort will overcome many difficulties. 
If one person can learn to write quickly and legibly with an arti¬ 
ficial hand, why should not another? If one person can handle 
a farming implement, such as a hoe, rake, ax, or wheelbarrow, or 
a carpenter can drive his plane, hold a nail or carry tools, there 
is no reason why others should fail. 



CHAPTER XIX 

WOODEN HANDS. RUBBER HANDS 


Old Methods. —During the first decade of our prothetical 
career (from 1853 to 1863), we manufactured mechanical hands, 
they were carved from wood with fingers jointed at the knuckles, 
controlled by straps operated by the shoulder. By a forward 
motion of the opposite arm, the strap would apply a pulling 
force to the artificial hand and force it to open. By relaxing, the 
strain on the strap would be released and the hand would close. It 
would seem as though a hand of this character would be useful and 
valuable, but when the invariableness of the spring tension, 
the oppressive harness to be worn, and the exertion required to 
operate the straps were considered, it was doubtful that the results 
obtained justified the means employed. 

New Methods. —In 1863 our attention was attracted to the 
utilization of rubber, the resilient nature of which appealed to us 
as being better adapted to the purposes of an artificial hand than 
harsh, unyielding wood or metal. The rubber hand was there¬ 
upon invented. It was cast in a mold made from the model of a 
natural hand, and it was attached to the end of the artificial fore¬ 
arm by means of a spindle. The fingers were flexible and would 
yield under pressure, having sufficient elasticity and adhesion 
to hold light articles. It presented a natural appearance and was 
pleasant to the touch. It was far more durable than the wooden 
hand. It might fall or strike a hard object and would not 
break. It could be slipped from the socket and a hook, knife, 
fork, brush, ring or other implement put in its place. For a 
number of years this hand found many purchasers, and was 



greatly admired. Improvements were suggested from time to 
time. 

Ductile Fingers.— A fortunate thought was that of changing 
the fingers from flexibility to ductility. Flexible fingers would 
move under pressure, but as soon as that pressure was released 

210 





A. A. Maries, Artificial Limbs, New York City. 211 


they would return to the positions in which they were cast. The 
ductile fingers admit of change of position. The wearer can, by 
the opposite hand, or by pressing the fingers against some resist¬ 
ant object, change their positions from full extension to clinched. 
The hand with fingers partly closed is sufficiently firm to carry 
a valise or package. Cut O 1 represents the rubber hand partly 
closed. The dotted lines indicate the positions of extension and 
flexion in which the fingers can be bent. 

Palm Locks. —A lock embedded in the palm, shown in Cut O 2, 
receives and holds implements with firmness. A hand brush, a 
knife and fork (as shown in Cut 0 3)- can be thus placed and 
have the appearance of being grasped by the fingers. When it is 
required to carry articles of considerable weight for a great length 
of time a steel hook is slipped in the palm socket, and, concealed 
by the hand, it is held with sufficient strength to carry.an article 
of one hundred pounds in weight. A knife or fork can be put in 
the same socket; the latter will hold a piece of meat while it is 
being cut with the opposite hand, and will convey food to the 
month. A brush placed in the palm lock can be used in washing 
the opposite hand. When it is desired to remove an implement 
a little pressure is applied to the button and the implement is 
released, and can easily be taken from the socket. 

Wrist Connections. —Rubber hands are attached to forearms 

by various methods. . 

Cut O 3 represents the spindle method. A steel spindle is 
attached to the base of the hand, and made to fit a locking plate 
secured to the base of the forearm socket. The hand when so 
placed will rotate at the wrist if the wearer wishes. When it is 




Cut 0 3. 


desired to remove the hand a little pressure applied to a button 
will release the hold, it can then be taken from its place. When 
it is desired to prevent the hand from rotating a set screw is 
turned inwardly, and the hand is clamped firmly in one position. 
A variety of implements are illustrated in the cuts O 4 to 0 7, 
each can be placed in the forearm substituting the hand. 

Clamps.— Cut O 8 represents a new device for a wrist-joint con¬ 
nection, it is intended for a person who works at the bench. The 

















212 A. A. Marks, Artificial Limbs, New York City . 


end of the forearm is made of aluminum, and provided with a 
sliding jaw operating as a vise. A cold chisel can be held firmly 
at any convenient angle, shown in Cut O 9; a saw-file can be used 
to advantage, as shown in Cut O 10. A jeweler’s hammer, or in 
fact any implement with a handle not greater than % of an inch 
in diameter can thus be held in a thoroughly practical way. 

Flexion. —The mortise and tenon wrist connection is preferable 



Cut 0 4. 



Cut O 5. 




Cut O 8. 


to any wrist mechanism that admits of flexion and extension. 
Cut O 11 represents this method. The mechanism consists of 
a series of interlaying strips, held together by a bolt, which forms 
the axis of motion. Rotation of the arm is obtained, when de- 



Cut O 9. Cut O 10. 


sired, by means of a bolt connection introduced immediately 
above the wrist joint. 

Cut O 12 represents the mortise and tenon connection, the hand 
flexed holding hook. Cut O 13 shows the hand extended, with 
fork held by the palm lock, the knife and other implements are 
held in the same way. 

For laborers who wish to obtain the greatest variety of prac- 













A. A. Marks, Artificial Limbs, New York City . 213 


tical uses from artificial arms, the spindle connection at the wrist 
(Cut O 3) is preferable. This device admits of greater strength 
and enables the wearer to press the artificial hand against any 
object desired to be held in place. The mortise and tenon wrist 



connection, illustrated in Cut O 11, is chosen by persons seeking 
ornament more than utility. 

When lightness is a paramount consideration it is advisable to 
have the hand permanently attached at the wrist. 

This method obviates any metal connection, and thereby lessens 
the weight. 

Spring Thumb. —We have a mechanical device by which the 
thumb can be made to move at its base, away from or toward the 
fingers. Cuts O 14 and O 15 represent the hand with the thumb ab- 



Cut 0 14. 


ducted; this is effected by tension applied to a cord passing from 
the under side of the base of the hand upwardly to the elbow. Cut 
O 16 represents the hand with thumb pressed against the finger. 
As soon as the tension of the abductor cord is released, the thumb 
will be forced by a strong spring to press against the index and 
middle fingers. WTaen the abductor cord is connected with the 








214 A. A. Maries, Artificial Limbs, New York City . 


artificial arm above the elbow, the thumb will press against the 
forefinger when the elbow is flexed, and will draw away from it 
when the elbow is extended, as shown in Cut O 16. The abductor 
cord may be carried up the arm, over the back, around the 
opposite shoulder, by which it will be controlled. When thus 



Cut 0 15. Cut O 16. 


connected it is independent of elbow motion and is operated 
by a movement of the shoulder or contraction of the chest. 

As considerable mechanism is required in the spring thumb, 
the construction is more or less complicated, and we do not ad¬ 
vise its selection except in special cases. In double amputations, 
when all dependence must be placed upon artificial means, spring 
thumbs are advantageous; but in single amputations they prove 
to be quite useless; the remaining natural hand becomes so 
adept that it performs about all the work that prior to the ampu¬ 
tation was performed by both hands. 

Gloves Always to Be Worn. —Artificial hands and parts of 
hands must be gloved at all times. This is necessary in order to 
conceal the fact that they are not real. Artificial hands, whether 
made of wood, rubber, or other material, may be modeled to the 
shape of nature, and have all the graceful lines, creases, and 
folds that are found in the natural hand.. 

They may be painted and tinted with artistic nicety, yet it is 
not possible to impart to them the characteristics which dis¬ 
tinguish nature from art. The natural hand has a different 
tint in the forenoon than it has in the afternoon; when the fingers 
are extended there are more creases in the skin than when they 
are flexed; when the hand is at labor it is broader and the 
muscles and blood vessels show with more prominence than when 
at repose. An artificial hand, no matter of what material it may 
be constructed, cannot possess this metamorphic power. It, 
therefore, must be concealed by a glove, otherwise it will be con¬ 
spicuous. 

Choice of Material for Sockets. —Sockets for artificial arms 
may be made of wood, leather, or aluminum, to suit the wishes of 
the purchaser. Makers of experience are united on this point, 
and advocate the use of tough, light wood. Wood is capable of 
being worked into convenient shapes, which it will retain indefi¬ 
nitely.. It is lighter than any other material that can be used 



A. A . Maries, Artificial Limbs, New York City. 215 


and when strengthened with rawhide is sufficiently strong for 
most purposes. It is also a non-conductor of heat, and when 
varnished does not absorb perspiration. The objection to leather 
is its flexibleness. While this may appear to be desirable, it is 
actually the cause of trouble. A socket that is flexible cannot 
be comfortable to wear, as it does not place the pressure at points 
of toleration; instead, it distributes it uniformly over the entire 
surface, causing pressure to come as much on sensitive parts as 
elsewhere. Leather absorbs perspiration, becomes foul and offen¬ 
sive, and unless extraordinary methods are used to keep it clean 
it will become hard and dead, it will crack and fall to pieces. 

Leather sockets are sometimes unavoidable; they will be spoken 
of in due course. 

Metal sockets are objectionable on account of their weight, 
liability to corrode from perspiration, and their disposition to 
hold heat. When arms are to be made for persons who work 
in water, such as dyers, laundrymen, fishermen, oystermen, etc., 
it will be necessary to use metal, such as aluminum, which re¬ 
ceives no injury from exposure to moisture free from salt. 

A rubber hand permanently attached to an aluminum socket will 
provide a useful, resistant, and durable arm, and when frequently 
cleaned and coated on the inside with sweat-proof enamel or paint 
will last a great many years. 



CHAPTER XX 

PARTIAL HAND AMPUTATIONS 


The loss of a finger may be lamentable, but it cannot be con¬ 
sidered a serious impairment. The remaining fingers as a rule 
are competent to perform all the labors that are usually demanded 
of the complete band. Yet there are times when the substitution 



of a lost finger is essential, either for cosmetic effect or to equip 
the hand for some special purpose; for example, playing the 
piano, or other musical instrument. 

The Loss of One Finger. —Cuts P 1 to P 6 represent hands 
from which one finger has been removed. An artificial finger 




Cut P 5. 


Cut P 6. 


Cut P 7. 


Cut P 8. 


similar in appearance to that illustrated in Cut P 9 meets the 
needs of each case. The loss of the thumb, far more than of a 
finger, impairs the usefulness of the hand. It is, therefore, more 
important to substitute that loss. Cuts P 7 and P 8 represent 

216 










A. A. Maries, Artificial Limbs , New York City. 217 


hands from which the thumb has been removed. An artificial 
thumb similar to that shown in Cut P 10 is suitable for such 
cases. 

Materials, —Artificial fingers and thumbs are made of rubber, 



Cut P 9. 


Cut P 10. 


or silver. Rubber is desirable, if flexibility is an ob¬ 
ject; silver has the greater durability, is neater, lighter, and 



more practical. The price is the same for each. When order¬ 
ing send a plaster cast of both the mutilated and opposite 



shaping the outside to correspond with its mate on the opposite 
hand. If the stump, either finger or thumb, is very short, it will be 
necessary to hold the substitute in place by straps passing around 









218 A. A. Maries, Artificial Limbs, New York City . 


the base of the hand, or by a glove. If the stump is long, the 
substitute will remain in place without additional support. 

It is important that the artificial part should be covered at all 
times by a glove, as it is not possible to give it the characteristics 
of nature closely enough to defy detection. 

The Loss of Two or More Fingers. —Cuts P 11 to P 22 repre¬ 
sent hands from which two or more fingers have been removed. 



Cut P 19. Cut P 20. 




Cut P 21. Cut P 22. 


An artificial part for any of these cases consists of rubber fingers 
attached to a socket that incases the remaining part of the natural 
hand. This is essential in order to hold the fingers together and 
provide means for securing them to the stump. 

Cut P 23 represents an artificial hand devised to supply the 
amputation of index and small fingers. Cut P 24 represents 



Cut P 23. 


Cut P 24. 


Cut P 25. 


Cut P 26. 


an artificial hand suitable for use when the index, middle, 
and small fingers are amputated. Cut P 25 shows an ar¬ 
tificial part to substitute the loss of middle and ring fingers. 
Cut P 26 represents an artificial hand, suitable for a palm 
amputation, in which the natural thumb remains. The fingers 
in all the above hands are made ductile, rigid, or flexible, 
according to the choice of the wearer. For those who do little 
work and wish to combine ornament with utility, the ductile 










A. A. Marks, Artificial Limbs, New York City. 219 


fingers should be chosen. For a laboring person, who wishes to 
lift heavy weights and do hard work, the rigid fingers are better. 
And for those who wear artificial fingers and parts of hands for 
ornamental purposes only, the flexible fingers give the greatest 
satisfaction. 

Individual Fingers. —Where the amputation of one or more 
fingers has been made at the first or second Joint, it will not be 



necessary to have the artificial fingers connected at their base; 
separate fingers, as represented in Cut P 9, can be used. 

Amputations that have been made in the palms of hands are 
capable of prothetic treatment, giving natural appearances to the 
mutilated members as closely as conditions will admit. If the 
remaining part of the hand provides a stump that will control 
the artificial part, a considerable amount of utility can be looked 




Cut P 31. Cut P 32. 



for; but if the stump is of such a character as to offer little or no 
leverage by which the artificial parts can be controlled, scarcely 
anything beyond ornament can be assured. 

Construction. —The hand below the fingers is made of rubber, 
combined with canvas and leather, providing a socket for the 
remaining part of the amputated member; this is laced on line 
with the palm. If the remaining thumb is greatly abducted, as 
shown in Cuts P 19 and P 20, caused by the weakening of the 
flexor muscles, it will be difficult to apply an artificial part that 










220 A. A. Maries, Artificial Limbs, New York City . 


will possess more than an approximate approach to nature in 
appearance. It will, nevertheless, materially improve the hand 
and add to its utility. 

When amputations remove the thumb, as well as the fingers, as 
shown in Cuts P 27 to P 37, the artificial hand required will re¬ 
semble that shown in Cut P 38. This hand is similar in construc¬ 
tion to that previously described. 

It must be noted that on account of the stump occupying the 



interior of the artificial palm, there can be no mechanism in the 
hand. When it is desired to have an appliance connected with the 
artificial part that will hold implements of utility, rings passing 
over the fingers, or plates riveted to the palms, must be used. 
These are only furnished when they are especially requested at the 
time the order is placed. 










CHAPTER XXI 
WRIST-JOINT AMPUTATIONS 
When a hand is amputated at the wrist articulation, the ulnar 




Cut Q 4. 




Cut Q 7. 


sometimes left as they are, as these prominences form means by 
which the artificial part can be held firmly to the stump. 

221 














222 A. A. Maries, Artificial Limbs, New York City. 


Flat Ends. —Cuts Q 1 to Q 7 represent amputations in the 
wrist, in which the styloid prominences of the ulna and radius 



are present. These stumps require artificial arms constructed on 
the plan shown in Cut Q 8. The hand is of rubber, with ductile 
fingers, a locking arrangement is imbedded in the palm, as 



Cut Q 12. 



described. The hand is permanently secured to a leather socket, 
which is formed on a cast of the stump. The arm thus con¬ 
structed is then placed on the stump and laced down the frontal 
line. Implements for the table, working, and for washing, etc., 













A. A. Marks, Artificial Limbs, New York City. 223 


can be placed in the palm, where they will be held firmly. Cuts 
Q 9, Q 10, and Q 11 show the various implements in place. 

Tapering Ends. —When the styloid prominences have been 
removed and the stump becomes a tapering one, as shown in Cuts 
Q 12 to Q 15, an artificial arm constructed on the plan of that 



represented in Cut Q 16 must be used. This arm is practically 
he same as that shown in Cut Q 8, with the exception that it is 
supplied with attachments that go above the elbow and connect 
with suspenders resting on the shoulders and passing around the 
body. These are essential to keep the arm from slipping off the 
tapering stump. Useful implements can be held in the hand, as 
shown in Cuts Q 9, Q 10, Q 11. 













CHAPTER XXII 

FOREARM AMPUTATIONS 


When an amputation has been performed at any point between 
the elbow and wrist, the stump that remains is called a forearm, 
or radial stump. Cuts R 1 to E 6 represent forearm stumps of a 
variety of lengths and conditions. The most suitable artificial 
arm for an amputation of any of the above is illustrated in Cut 
R 7. The socket is of wood, leather, or metal, as may be selected, 
shaped interiorly to receive the stump in the most accommodating 



Cut R 1. Cut R 2. 


way. The outside is given the contours of the natural arm as 
closely as conditions will admit, it is then covered with rawhide 
and enameled a natural tint. 

Leather Elbow Joints— The arm being intended for a long 
radial stump, the connection with the upper arm piece (incasing 
the muscle part) is of flexible leather, so as to permit a great 
range of motion; being adjustable, it can be tightened or loosened, 
as required; it is absolutely noiseless and very strong; being 
flexible, it admits of rotation of the forearm. The hand is of 

224 





A. A. Maries, Artificial Limbs, New York City. 225 



Cut R 5. Cut R 6. 

rubber, with ductile fingers, as heretofore described. The con¬ 
nection at the wrist is by the spindle or the mortise and tenon 
method, or the hand can be permanently attached. 












226 A. A. Marks, Artificial Limbs, New York City. 


The part incasing the arm above the elbow is made of leather, 
with suitable straps for regulating pressure. Shoulder straps and 



Cut R 9. Cut R 10. 


suspenders are attached to the upper part of this section. 

Arms of this construction are thoroughly available for stumps 
below the elbow five or more inches in length. 


















A. A. Marks, Artificial Limbs, New York City . 227 


It is sometimes desirable in long radial stumps to secure the 
arms by a narrow strap above the elbow instead of by the long 




Cut R 11. Cut R 12. 


leather muscle part. Cut R 8 represents an arm of this character. 
This method of attachment is adequate when the artificial arm is 



Cut R 13. 


not used for carrying heavy articles or in performing laborious 
work. 

Steel Elbow Joints. —Radial stumps that are shorter than five 
inches, as shown in Cuts R 9 to R 12, require a firmer method of 
securing the stump socket to the upper-arm part than the leather 












228 A. A. Maries , Artificial Limbs, New York City. 


joint above described. Cut It 13 represents an artificial arm 
constructed practically the same as R 7, differing in the elbow 
joint. Steel hinge joints are used instead of leather. While 
there is less freedom in the elbow movement, the steel joints place 
the arm under firmer control of the stump. 

Short Stumps. —This arm is, as a rule, made with hand perma¬ 
nently attached, in order to minimize weight. When an amputa¬ 
tion below the elbow leaves a stump so short that when flexed the 



Cut R 14. 


projection beyond the line of the upper arm is insufficient to 
control the movements of the elbow, it must be treated the same 
as an amputation in the elbow joint, as described in the follow¬ 
ing chapter. 

Arms without Hands. —Peg arms for radial stumps are of 
several kinds, made of wood, leather, or aluminum; they are 
practically artificial arms without hands. Cut R 14 represents a 
peg arm without long muscle part or suspenders. Cut R 15 shows 
a peg arm with long muscle part and suspenders; both the 



Cut R 15. 


above peg arms are constructed in the same manner as those here¬ 
tofore described, the absence of the hand is the only difference. 
Farming, shop, and other implements can be devised for specific 
purposes and held in the ends of the forearms. 

Suspenders. —Cut R 16 represents a suspender suitable for an 
arm for a radial amputation. Suspenders must be renewed occa¬ 
sionally, according to the demands that are made upon them by 





A. A. Maries, Artificial Limbs, New York City. 229 


the wearer. If the arm is used by a laboring person and he per¬ 
spires very freely, a new suspender will be required more fre¬ 
quently than if less destructive conditions prevail. The suspender 
can be procured independent of other parts. It consists of a 



Cut R 16. 


plate of leather shaped to rest on top of the shoulder and fit close 
to the neck. A webbing strap passes around the body under the 
opposite arm and buckles to the suspender in front. 






CHAPTER XXIII 
ELBOW-JOINT AMPUTATIONS 
Amputations in or immediately below the elbow joints, leaving 



Cut S 1. 


stumps so short they cannot be availed of in controlling tbe arti- 



Cut S 2. 


■filial elbow joint, require artificial arms of special construction. 

230 





A. A. Marks , Artificial Limbs, New York City. 231 


The presence of the condyles, or bony prominences, affords an 
opportunity for fitting that will secure firmness without employing 
shoulder straps, or, if not dispensing with them entirely, simplify¬ 
ing them very materially. 

Short Radial Stumps. —Cut S 1 represents an amputation a 
little below the elbow joint, but very close to it, leaving a stump 
so short that it cannot be utilized. A suitable arm is illustrated 
in Cuts S 2 and S 3. This arm is especially designed for an 
amputation through the elbow joint. 

Construction. —The forearm is made of wood, shaped to the 
contours and dimensions of the natural arm, excavated to receive 



the stump properly and to reduce weight, covered with rawhide 
to obtain strength, and finished in enamel. The hand is of 
rubber, attached to the forearm by either of the methods hereto¬ 
fore described. The palm is provided with a locking arrange¬ 
ment that will hold implements of utility. The elbow joint is of 
the ginglymoid pattern and is operated by a flexion strap under 
control of the opposite shoulder. The elbow joint is provided with 
a locking arrangement that will hold the arm in flexed position 
when desired. The socket receives the stump, which, on account 



232 A. A. Marks, Artificial Limbs, New York City. 


of its enlarged extremity, is inserted from the front and held by 
lacing. Cut S 3 represents an artificial arm practically the same 
as an S 2, except that the stump is placed in the socket from the 
rear instead of the front. Cut S 4 represents the same with the 
hand slipped off and a hook inserted in the end of the forearm. 
This can only be done when the arm is so constructed that the 
hand is connected with the forearm by the spindle attachment. 
In style S 3 the upper section is made entirely of leather, formed 
on a cast of the stump, modified as the conditions require. 

Arms without Hands. —Peg arms for elbow-joint amputations 
are found useful for laboring purposes. Cut S 5 gives the 
simplest form. It is without articulation at the elbow. It 
receives the stump from the front and is held in place by lacing; 
it may be made of wood, leather, or aluminum. When made of 
wood it is strengthened with rawhide and enameled. The end of 
the socket is provided with a wrist plate for holding useful imple¬ 
ments. When the conditions of the stump require, a suspender 
is provided which rests on top of the shoulder and held in place 
by a strap passing around the body under the opposite arm. The 
arm, as shown in the cut, is usually made slightly bent at the 
elbow and approximately the length of the opposite arm. When 
elbow-joint motion is required it becomes the same as S 4, with¬ 
out a hand. 

Suspenders are the same as those used on arms for above-elbow 
stumps. 



CHAPTER XXIV 


ABOVE-ELBOW AMPUTATIONS 


An amputation at any point between the shoulder and elbow 
produces what is known by surgeons as a humeral stump. Cuts 
T 1 and T 2 are fair examples. 



Cut T 1. Cut T 2. 


Artificial arms suitable for humeral stumps are usually provided 
with artificial elbow articulations, which are flexed and extended 
by a swing of the body or by the contraction of the shoulders. 



Cut T 3 represents such an arm extended at the elbow, and Cut 
T 4 represents it with the elbow joint flexed. 

This arm is usually constructed of wood, shaped to the con- 

233 






234 A. A. Marks, Artificial Limbs, New York City. 


tours and dimensions of the opposite arm, excavated to reduce 
weight, covered with rawhide to add strength, and enameled a 
flesh-like tint. The hand is of rubber, attached to the forearm by 
either of the methods heretofore described. The palm is pro¬ 
vided with a locking arrangement for holding laboring, eating, 
and other useful implements. The joints at the elbow are of a 



Cut T 4. 

substantial character, combined with an attachment that will hold 
the forearm at one or more desired angles. 

Elbow Lock. —The locking arrangement is released by pressure 
applied to button protruding from the under side of the forearm. 
Suitable suspender is represented in Cut T 5. This can be 
renewed, as occasion may require. By an ingenious attachment 
rotation of the elbow is obtained when length of stump will 
permit. 

Peg arms for upper-arm amputations are of several kinds. Cut 
T 6 represents the least expensive. It is usually made of wood, 
excavated to receive the stump properly and to reduce weight, and 



shaped on the outside to have the form and dimensions of the 
opposite arm. The end of the socket is provided with a catch 
that will hold implements of utility. This arm is partly flexed 
and immovable at the elbow, as it is found to be more convenient 
that way. If a peg arm with elbow-joint motion is wanted, it 
becomes the same as T 4 without a hand. 





CHAPTER XXV 


SHOULDEK-JOINT AMPUTATIONS 


Amputations that are made in the shoulder joints leave short 
muscle stumps or no stumps at all. They require artificial arms 
the same as when amputations are between the elbow and shoul¬ 
der joints. 

Cut U 1 represents a shoulder-joint amputation, leaving a 
muscle stump. Cut U 2 shows a shoulder-joint amputation with 



no stump, and Cut U 3 represents a congenital malformation, the 
clavicle turned upward at its extremity, affording a knob, or 
prominence, on which an artificial arm can be securely adjusted. 

An artificial arm constructed on the plan of that represented in 
Cut U 5 is suitable for any of the above cases. The manner in 
which it is applied and held by body strap is shown in Cut U 4. 

Artificial arms are quite necessary in shoulder amputations or 

235 






236 A. A. Maries, Artificial Limbs, New York City . 


malformations; they keep the shoulders in position, restore sym¬ 
metry to the body, and provide a means for assisting the other 



Cut U 3. ' Cut U 4. 


arm. By a shrug of the shoulder, the artificial arm is thrown 
forward, the flexion strap is contracted, and the elbow bends. 

Young persons become very dexterous in manipulating arms 
under these conditions; they have been known to operate them 
so skillfully that few persons ever suspect the arms to be artificial. 



Artificial arms for shoulder-joint amputations are constructed 
essentially the same as those for amputations between the elbows 
and shoulders. In addition to the usual stump socket there is a 













A. A. Maries, Artificial Limbs, New York City. 237 


pad that runs well above the top and over the shoulder, resting 
on the shoulder close to the neck. The stump is held in position 
by a strap passing around the body under the opposite arm. The 
elbow joint admits of flexion and extension, and is provided with 



Cut U 6. 


a locking arrangement that will hold it at right angles. The 
attachment can be released by pressure applied to a press-button 
immediately under the forearm. Cuts U 6 and U 7 represent the 
arm flexed at right and oblique angles. 



Cut U 7. 


Peg arms for shoulder-joint amputations are practically the 
same as those for above-elbow amputations, and are described 
in previous chapter. 
















CHAPTER XXVI 


DOUBLE ARM AMPUTATIONS 

The amputation of both arms is a deplorable loss and presents 
the strongest appeal to the artificial limb maker. The subject is 
absolutely dependent upon others unless artificial arms are applied. 
He is neither able to feed himself, prepare his food, dress himself, 
or perform labor of any kind. Something must be done to better 
his unfortunate condition. If not, he is obliged to remain depend¬ 
ent upon some kindly disposed friend or relative. Anything that 



Cut Y 1. Cut Y 2 . 


will help him in his condition, no matter how little, will be a 
benefit and will materially lessen the burden on others. 

Cut Y 1 represents the amputation of both forearms, leaving 
stumps that are long and powerful. Cut Y 2 represents double 
forearm amputations, stumps short. Cut Y 3 shows artificial 
arms applied. Artificial arms, under control of long and power¬ 
ful stumps, will enable the wearer to prepare his food at the 
table, convey it to his mouth, perform labor of a great variety, 
carry articles of considerable weight, write a legible hand, open 
and close a door, and attend to the adjustment of his own attire 

238 


A. A. Maries, Artificial Limbs, New Yorlc City . 239 



to a reasonable degree. When the stumps are short, the range of 
utility is correspondingly lessened. 








240 A. A. Maries, Artificial Limbs, New Yorle City . 


The use of spring thumbs is always desirable in double arm 
amputations, and unless otherwise instructed, we assume that 
they are wanted and construct the hands accordingly. 

Cut V 4 represents double arm amputations, one immediately 
above the wrist, and the other above the elbow. Cut V 5 repre¬ 
sents similar cases, with artificial arms applied. 

Cut V 6 represents amputations of the right hand at the wrist 
and the left arm at the shoulder. A pair of artificial arms were 
applied to this case with gratifying results. 

The right artificial arm was under control of the natural elbow. 
The left was secured to the stump by straps with a locking attach¬ 
ment at the elbow and clamp at the wrist. Considerable labor 



Cut Y 7. Cut Y 8. 


was capable of being performed by the right, the left arm depend¬ 
ing upon a strap passing around the body for flexion and exten¬ 
sion of the elbow. 

Cut Y 7 represents a young man with both arms amputated 
above the elbows, the result of a railroad accident. Cut Y 8 
shows him with a pair of artificial arms applied. As may be 
surmised, the arms were of very limited use, but, nevertheless, 
they mitigated his affliction to a compensating degree. By the 
working of his right shoulder, he was able to bring the artificial 
forearm to right angles. In this position- it would remain, pro- 






A. A. Maries, Artificial Limbs, New York City. 241 


viding a means by which articles could be laid on the forearm 
and carried. His left arm could be flexed by means of the stump, 
which was long and powerful. When at extension, a pail, basket, 
or valise could be carried, and other services performed. The 
arms rescued him from a life of absolute idleness. 

Cut Y 9 represents a man who, while attending his duties on a 
railroad, was overtaken by a severe storm, and before he could 
reach shelter, both feet and hands were frozen. It was necessary 
to amputate the right hand between the thumb and wrist and the 
left at the base of the fingers and thumb. The great toe was 
removed from the right foot, and left leg amputated a little above 



Cut Y 9. Cut Y 10. 

the ankle. The same cut shows a pair of artificial hands and an 
artificial left leg suitable for the case. Cut Y 10 represents the 
limbs applied. Each hand had moving thumbs, which were con¬ 
nected with levers, operated by the forearm. When the stumps 
were flexed the levers would force the thumbs against the index 
and middle fingers. When the stumps were extended this pressure 
was released, and the thumb was permitted to withdraw. An 
artificial leg was applied to the left side. By these appliances 
this person was rendered capable of earning his livelihood. 











CHAPTER xxvrr 


APPLIANCES FOE DEFOKMITIES, EXCISIONS, 
WEAKENED JOINTS, ETC. 

In cases of unnnited fractures of either bone of the forearm or 
of the elbow joint or upper arm, it is necessary to apply a brace 
constructed upon durable lines and capable of being removed and 
readjusted as conditions require. Cut W 1 shows an apparatus 
for an ununited fracture. The forearm and muscle parts are con- 



Cut W 1. 


structed of material sufficiently firm to serve the purpose. They 
are connected by articulating joints that work in harmony with 
the elbow, or supply the elbow motion; the parts are adjustable by 
lacing, they bold the bones in place and give strength and firmness 



Cut W 2. 


to the fractured member. Cut W 2 represents an apparatus for 
elbow-joint resection or for dislocated shoulder joint. The forearm 
and muscle parts are made of suitable material and are connected 
by steel joints. The muscle part is provided with a hood, which 



Cut W 3. 



Cut W 4. 



Cut W 5. 


rests comfortably upon the shoulder. When necessary, a strap 
connected with the hood is passed around the body, bolding the 
appliance firmly in place. 


242 







A. A. Maries, Artificial Limbs, New York City. 243 


Cut W 3 represents a hand mutilation, the subject being a 
sailor, requiring an appliance that would enable him to hold a 
rope, tie a knot, climb the shrouds, and carry articles about a 
vessel. Cut W 4 represents a socket composed of canvas, rubber. 



and leather, formed to fit the mutilated hand, with apertures to 
admit the passage of the remaining fingers; a steel, flattened hook 
was riveted between the apertures. Cut W 5 represents the 
apparatus applied, which proved to be useful and satisfactory. 




Cut W 9. Cut W 10. 



Cut W 11. 



Cut W 12. 


There are many cases of deformities, resections, etc., of the 
upper extremities that can be treated practically the same as 
amputations. They require artificial parts that incase the weak¬ 
ened members and strengthen them. 
















244 A. A. Maries, Artificial Limbs , New York City. 


Hands and parts of hands are attached to malformed members 
so as to correct the deformity and supply the want to a degree 
sufficient to make the remaining parts useful. Cut W 6 represents 
a deformity of the forearm, the elbow joint possessing normal 
conditions. This deformity case was treated as an amputation 
below the elbow, adjustments to meet the peculiarities of the 






Cut W 13. Cut W 14. 


Cut W 15. Cut W 16. 


stump. Cut W 7 represents a deformity of elbow joint and fore¬ 
arm, a very slight movement remaining in the elbow, the forearm 
terminating in an enlargement. An artificial arm, constructed 
similar to one for wrist-joint amputation, was made and applied. 

Cuts W 8 to W 20 represent congenital deformities of the 
hands. 

In these cases, the conditions being somewhat similar to ampu- 



Cut W 17. Cut W 18. Cut W 19. Cut W 20. 


tations, artificial hands for partial hand amputations, as illus¬ 
trated and described in Chapter XX., were applied. 

Cut W 21 represents a European prince of distinguished line¬ 
age. When an infant, he fell from his nurse’s arms, paralysis of 












A. A. Marks , Artificial Limbs , New York City. 245 


the right arm followed. As he grew to manhood, the affected 
member grew in length, but failed to develop in size. It was limp 
and useless. In 1893 he came to us, and, upon examination, we 
found that the entire right side of the thorax was undeveloped, 
and that an artificial arm could be applied without producing 
noticeable disproportion. The case was treated the same as a 
shoulder-joint amputation, and an arm constructed accordingly 
was attached outside the withered member. The supporting part 
covered a great area of the shoulder, chest, and back; this held 




the artificial arm in place, as shown in Cut W 22. In dressing, 
the withered arm was (as had always been the custom) permitted 
to rest close to the body, the clothing was placed between the 
artificial and the withered arm, and, when dressed, the prince 
presented an appearance that was beyond criticism, as shown m 
Cut W 23. 

































CHAPTER XXVIII 


AKM IMPLEMENTS 

Implements for artificial arms are of endless variety: hooks, 
knives, forks, clevises, claw-hooks, pincers, clamp rings, are a 
few of the many devices that have been made for persons whose 
occupations demand something aside from the usual line. Each 
arm we make is supplied with a hook, knife, fork, and brush. 
These are included in the cost. Additional implements are fur¬ 
nished when desired, and if a customer desires one made to order 
for any special purpose, we will gladly make it for him. Our 
charges for the same will be moderate. 

Cut X 1 represents a table knife, Cut X 2 a table fork, Cut 
X 3 a hand or nail brush; these are fitted to slip in the palm of 



hand or in the end of the forearm. They are of great assistance 
at the table and in washing the opposite hand. 

Cuts X 4 and X 5 are hooks to be carried in the palm of the 
hand or in the end of the forearm. They are made with straight 
shanks, so that they can be received in the palm, are of two sizes, 
large and small, as shown in the illustrations. 

Cut X 6 is a round hook, to be used in the end of the forearm. 
The curved back prevents it being placed in the palm of the hand. 
Cut X 7 is a claw hook, to be used in the end of the forearm. 
One part is made with two prongs and the other with one; it can 

246 
















A. A. Maries, Artificial Limbs, New York City . 247 


be opened, closed, and set. This device enables a mechanic to 
clasp a tool with firmness. 

Cuts X 8 and X 9 show rings which can be placed in the end 
of the forearm. One is immovably attached to the shank, and the 
other is loose; either is serviceable for mechanics and farmers. 
Through the ring the handle of a tool, or farm implement, can 
slide, while the tool is directed by the opposite hand. 

Cut X 10 shows a clevis to be used for holding shop or farm¬ 
ing implements. A quarter-inch hole must first be bored through 
the handle of the tool to be held, then the pivot pin unscrewed 
and the clevis placed over the handle, the pivot pin passed through 
one tine of the clevis, through the hole in the handle, and then 



Cut X 8. Cut X 9. Cut X 10. 


screwed into the other tine. This will hold the tool in an accom¬ 
modating way, and permit it to swivel. 







CHAPTER XXIX 


UTILITY 

Although claim is not made that an artificial arm possesses 
functions comparable to those of the natural, it is contended that 
a reasonable and a compensating amount of utility is assured. 

The wholesome effect an arm has on the stump, that of keeping 
it in a healthy and vigorous condition, protecting it from injuries, 
forcing it into healthful activity, together with its ornamental 
aspect, are sufficient reasons for wearing one, even if utility is 
totally ignored. 

As before stated, there are persons who have more aptitude than 



Cut Y 1. 


others. Some with very short stumps do more than others with 
long ones. 

Notwithstanding how short a stump may be, there is always a 
possibility of its controlling an artificial arm to advantage. If 
one person can use an arm on a short and difficult stump, there 
is hope that every person can do likewise, no matter what length 
or kind of stump he may have. 

A few cases are presented, to give some idea of the scope of 
the value of artificial arms from the utility point of view. 

248 













A. A. Maries , Artificial Limbs, New York City. 249 



One of our lady patrons is an amanuensis. While she is holding 
and guiding a pen with her rubber hand, she is keeping the paper 
from sliding on the desk with her natural hand. She writes 



n n n 

Cut Y 3. 



Cut Y 4. 


quickly and legibly and earns her livelihood by that employment. 
Out Y 1 represents her at the desk. 

One ot oui patrons, a physician, who is engaged in general 
country practice, wearing an artificial arm for amputation below 























250 A. A. Marks, Artificial Limbs , New York City. 


the elbow, finds his rubber hand convenient and valuable in hold¬ 
ing the reins of his horse while driving. (See Cut Y 2.) 

Mr. Woolley, of Ohio, is a ticket agent at a railroad station. 


Cut Y 5. 



He has held the position for a number of years to the satisfaction 
of the company. He holds tickets in his natural hand while he 
operates the stamp and dating machine with the rubber one. 
(See Cut Y 3.) 



W. G. Bray, of Dunklin County, Mo., lost his arm below the 
elbow some years ago. He has worn an artificial one since. He 
is a clerk in a store and has to handle all kinds of heavy mer- 


















A. A. Maries, Artificial Limbs, New York City. 251 


chandise. He handles a wheelbarrow to advantage. (See Cut 
Y 4.) 

Cut Y 5 represents a customer who uses his rubber hand in row¬ 
ing a boat; he is a farmer, located on the banks of a river, and 
finds it necessary to cross the stream frequently. 

Mr. Ely, of Windham County, Conn., has no difficulty in work¬ 
ing with other laborers and earning laborer’s wages, although he 
has to do a great amount of work with the pickax. His right 
arm is artificial. (See Cut Y 6.) 

A physician in Michigan writes that his patient, for whom he 
bought an artificial arm, has learned to operate the key of his 


Cut Y 8. 



Cut Y 9. 


telegraph apparatus very skillfully with his rubber hand. (See 

^ The accompanying Cut Y 8 portrays a railroad conductor who 
wears an artificial arm and holds the ticket in his rubber hand 
while he operates the punch with the other. 

A patron, residing in Providence, wears an artificial arm on a 
short shoulder stump; he could not be induced to do without it; 
it exercises his shoulder, improves his appearance. He finds the 
rubber hand a great convenience in holding cards while playing 
whist, a game he is greatly attached to. (See Cut Y 9.) 
















CHAPTER XXX 


DIRECTIONS FOR TAKING MEASUREMENTS FOR ONE 
OR A PAIR OF ARTIFICIAL ARMS 

Place a sheet of paper (about twenty or thirty inches) on a 
smooth table, remove all clothing from the upper part of the 
body, and place both arm and stump on this paper at full length. 
Be sure that the edge of the paper presses closely against the 
chest. Pass a long pencil down the inside of the arm (Cut Z 1), 
around the fingers, and up the outside to the shoulder. Then pass 
the pencil around the amputated side, from body around end of 
stump, and up to the shoulder (Cut Z 2). Bend the elbow of the 
sound arm to about right angles, mark from the shoulder around 
the elbow, down the forearm, around the hand, up the inside 



Cut Z 1. Cut Z 2 . 


to the shoulder (Cut Z 3). Bend the elbow of the amputated arm 
to right angles and mark around it, from the shoulder to the end 
of the stump (Cut Z 4). If these diagrams are correctly made, 
they will resemble Cuts Z 5, Z 6, Z 7, and Z 8. 

With a tape line measure the distance from the point of 
shoulder to the point of elbow of the sound arm, also the distance 
from the armpit to the bend of elbow (indicated by dotted lines 
in Cut Z 7). Measure the distance from the point of the shoulder 
to the point of the elbow of amputated arm, also the distance 
from the armpit to the bend of elbow. Give the circumference of 
each arm at points two inches apart, beginning close to the body. 
These circumferences are represented by dotted lines A, B, C, D t 

m 




A. A. Marks, Artificial Limbs, New York City. 253 


E, and F of sound arm, and the dotted lines A, B, C, D, E, F„ 
G, and H in the diagram of the stump (Cut Z 5). Then give the 
circumference of the hand at the base of the thumb, the circum¬ 
ference of the palm at the base of the fingers, the circumference 



of the thumb at the first joint, represented by dotted lines G, H, 
and I (Cut Z 5). 

If one arm is amputated in or above the elbow, the diagrams 



Cut Z 5. 



and measurements of the sound arm called for by Cuts Z 5 and 
Z 6 are required, and only one diagram of the stump, together 
with circumferences at places two inches apart, the distance from 
















254 A. A. Marks, Artificial Limbs, New York City . 


point of the shoulder to the point of the stump and from arm- 
pit to the point of the stump are also required. 

If both arms are amputated above the elbow, diagrams of each 
stump, and the distances from the point of each shoulder to the 
point of each stump, and from armpit to the point of each stump 
are required, also the circumferences of each taken at points two 
inches apart. 

If both arms are amputated below the elbows, the diagrams and 
measurements may be taken as suggested by Cuts Z 6 and Z 8. 

All amputations in the shoulders, elbows, or wrists, or in the 
hands, leave extremities that are bony, more or less sensitive, 
requiring very exact fitting. Such stumps should be reproduced 
in plaster. 

Answers to the following questions should be attached to the 
blank and forwarded with every order: Name of patient? Post- 
office address ? Occupation ? Age ? Cause of amputation ? When 
was amputation performed? Which arm amputated? Has the 
patient worn an artificial arm? If so, whose make? Name of 



party ordering? His address? Is the arm to be made and fitted 
from measurements in the absence of the wearer? To what ad¬ 
dress shall it be shipped? 

Plaster casts of arm stumps are only required in amputations in 
the wrists, elbows, shoulders, and in the hands, and in other cases 
when there are peculiarities that cannot be clearly indicated by 
the diagrams. A dentist, wax flower maker, or plaster statuette 
maker is familiar with the manipulation of plaster, and if one is 
available he should be employed for the purpose. The operation, 
however, of taking a plaster cast is not difficult, and can be done 
by almost any person. 

The simplest method is as follows: Remove all clothing, shave 
away all hair, or stick it down with glue, paste, thick plaster, or 
thick soap. Then place about two quarts of plaster of Paris 
in a basin containing one quart of water, stir it up thoroughly, 
so that the plaster will become pasty. Then spread it upon the 
stump, until it is entirely covered with at least one-half an inch 
in thickness. The stump should be kept very quiet until the 






A. A. Maries , Artificial Limbs , New York City. 255 


plaster has become hard, at which time it can be withdrawn, and 
the plaster will form a mold of the stump. This can be sent to us, 
or, if preferred, the inside can be greased and filled up with 
slaked plaster of Paris, which, when hard, can be taken from 
the mold. 

If the end of the stump is large, or if there are prominences on 
the stump, it will be necessary to make the mold in two parts, so 
that they can be separated when hard, and the stump removed. 
The simplest way is to spread a little slaked plaster on the 
table, lay the stump upon it, pressing it down until it sinks half 
way into the plaster (see Cut Z 9). Then lay pieces of thin, wet 
paper all over the exposed surfaces of the plaster. Then pour and 



Cut Z 11. Cut Z 12. 


spread plaster on the top of the stump (Cut Z 10). Let the plaster 
run down the sides on the paper. The stump should be covered 
with at least one-half inch in thickness. When it has become thor¬ 
oughly hard, the piece of paper will permit the plaster to separate 
and the stump can be withdrawn. The mold thus produced can 
be sent to us, or, if preferred, a plaster facsimile of stump can 
be made from it, by first speading oil or grease in the mold, then 
placing the two parts together, tying them by a string; then mix 
plaster of Paris to about the thickness of cream and pour it 
inside the mold. When this has become hard, the mold can be 
separated and the cast withdrawn. 

ARMS PITTED FROM MEASUREMENTS 

Artificial arms can, as a rule, be fitted from measurements and 
diagrams, while the wearers remain at home. The same reasons 
that are given for fitting artificial legs from measurements apply 
to arms. The guarantees that we give protect the ordering party 
in the strongest possible way. Should an arm fail to fit acceptably, 
when made from measurements, it may be assumed that the stump 
has changed, or that there are peculiarities about the stump which 
have not been made known. No matter what conditions may be 











256 A. A. Marks, Artificial Limbs, New York City. 


responsible for such misfit, the arm can be returned, with particu¬ 
lars, and all the needed alterations or reconstructions will be made 
by us without charge, or, if the wearer desires, he can at that time 
sail upon us and have the arm refitted and readjusted directly to 
his stump. It will thus be seen that the conditions under which 
fittings are made from measurements are entirely in the interest 
of the wearer. As a rule, fitting from measurements results in 
saving the party expense, annoyance, and loss of time in traveling. 

Prices are printed on leaflet appended to the last chapter of this 
book. 

Accessories. —Artificial arms for wrist-joint, forearm, elbow- 
joint, above-elbow and shoulder-joint amputations will be accom¬ 
panied, free of charge, with necessary suspenders, sock for the 
stump, knife, fork, hook, pair of gloves, etc. 

Peg arms for the above amputations will be accompanied with all 
the above-mentioned articles except gloves. 




CHAPTER XXXI 


TERMS OF PAYMENT, INSTALLMENT PAYMENTS, 
GUARANTEE 

Advance Payment Avoids Delay.— An article so important as 
an artificial leg or arm, which has to be made expressly to order 
for the person who is to wear it, should be paid for in advance. 
Time and expense are saved by doing so. If, however, objection 
is made to paying the full amount in advance, one-half the value 
can be forwarded with the order and the balance paid on delivery. 

How to Make Payments. —Remittances can be made by bank 
draft on New York, by postal money order, by express money order, 
or by money package by express. All drafts should be made pay¬ 
able to the order of A. A. Marks. 

Our Reliability. —Every assurance is given that the interests 
and the welfare of the wearer will be subserved in every detail. 
Our reliability and business and financial standing can be ascer¬ 
tained by consulting any mercantile agency. 

Success Most Important to Us.—It is of the greatest impor¬ 
tance to us that every client shall be satisfied, not only with the 
fitting and construction of his artificial limb, but that he shall 
become clever, skillful, and dexterous in its use. He must do this 
in order to reflect credit on our skill. We take as much pride in 
the successful results of our work as do our clients. 

As manufacturers, we cannot afford to neglect, or hastily dismiss 
a case, or show a lack of interest, or the least hesitancy in doing 
everything that is possible for the relief and comfort of our patrons. 
Wisdom compels the strictest integrity in the discharge of every 
obligation. Trouble and expense are not to be considered when 
disappointment and displeasure can be averted. No establishment 
can exist long that becomes careless, or allows its conduct to be 
criticised or impugned. 

Advanced Payments Are in the Interest of the Wearers.— 
Payments in advance may be looked upon by some as arbitrary and 
unreasonable, but by the man of business they are viewed in the 
proper light, and not objected to. As a matter of fact, the best 
and most skillful services are always paid for in advance. If you 
wish to send a letter, you must attach a stamp to the envelope, and 
the stamp must be paid for when purchased, before the letter is 
delivered. This may appear to be a small matter, but to publishers 
and business men who have large correspondence, it amounts to 
hundreds of dollars every day. If you wish to send a telegram, 
you must pay for it in advance. If you want a telephone in your 

257 


258 A. A. Marks, Artificial Limbs, New York City. 


house, you must pay a month's fee in advance. If you wish to 
travel by land or sea, you must buy your ticket before you start; 
not after you have finished your journey. If you want a Lorenz 
to perform a surgical operation, you must pay him before he leaves 
his home. If you want a Makart to paint your portrait, you must 
pay him before he will entertain your order. And so it goes, the 
world over. The best talent and the most skillful services are only 
obtainable by paying in advance for them. The richest men the 
most reputable merchants—have always to yield to these terms 
when they seek the best. 

The same can be said of artificial limbs. The best can only be 
obtained by meeting the maker’s terms. The poorest, those made 
by the inexperiencd, can be obtained upon any terms that the pur¬ 
chaser may wish to make. 

The question then resolves itself into whether the applicant 
prefers to get the best limb, and pay for it in advance, or whether 
he is willing to put up with the product of an unskilled maker, 
merely to have his notion indulged regarding payment. 

Artificial Limbs on Trial, Prejudicial to Success. —It has 
been said that “ things that are not paid for are good for nothing,” 
and, as a matter of fact, articles that are constructed and sold 
under the consideration that they can be accepted or rejected, are, 
as a rule, rejected. It is safe to estimate that at least seventy-five 
per cent, of the artificial limbs that are made and delivered by 
small, inexperienced, and eager manufacturers, with the under¬ 
standing that they can be tried for a reasonable length of time, 
and if not satisfactory, can be returned, are thrown back on the 
hands of the maker, and as these terms are only allowed by the 
maker of small means, he cannot afford to lose the time and ma¬ 
terial expended in the rejected limb. He, therefore, makes some 
slight alterations in the limb, and passes it to the next victim. 
There is, therefore, a strong probability, when placing an order 
with a manufacturer who permits his work to be returned, of 
getting a limb that was originally made for some other person. 

Why Correctly Made Limbs are not Always Pleasant at 
the Start. —An artificial limb, no matter how scientifically it may 
be made and correctly fitted, is not a very comfortable article to 
wear during the period required to get accustomed to it. During 
this time there are many moments of discouragement. The stump, 
being weak, soon tires and fails to control the limb, and because 
of this weakness, the wearer gets discouraged and either concludes 
that the limb has not been properly made and fitted, or that his 
stump is of a character that will never control one. If the leg is 
not paid for, it will in all probability be rejected and returned to 
the maker during one of these periods when the wearer is in a 
discouraged frame of mind. 

Patient Endeavor Brings Its Beward. —If, on the other hand, 
the limb is paid for, the effort to wear it will be repeated again 
and again, until finally the task is accomplished, and the services 
derived will prove to be valuable beyond calculation. Viewing the 



A. A. Marks , Artificial Limbs , New York City. 259 


subject in this aspect, it will be seen that the fact that the limb 
is paid for has a stimulating effect on the wearer, impelling him to 
put forth further effort. 

Money Deposited in Banks Not Acceptable. —The proposition 
to place money for the payment of the limb on deposit with some 
bank, to be paid to us as soon as the limb is received and found 
satisfactory, is often made. We invariably decline to accept such 
terms, as money deposited is subject to such conditions that the 
feature of security is removed. The money cannot be drawn, 
unless the party ordering the limb gives his consent. If he de¬ 
clines to accept the limb from caprice, or hasty judgment, he can 
demand his money, and we have no redress. 

Installment Payments. —We are willing to accept payments on 
the installment plan to accommodate those in indigent circum¬ 
stances, provided such obligations are imposed as will make the 
payments absolutely sure from the legal point of view. On an 
order for an artificial leg the first payment must be at least one- 
third its value, and for an artificial arm, one-half its value; and 
this amount must accompany the order. The balance can be paid 
in large or small amounts—weekly, monthly, or at other periods— 
as may be desired. Deferred payments must be secured by the 
indorsement of a reliable business person who has an acceptable 
mercantile rating. 

Deferred Payments Must Be Guaranteed.— The deferred pay¬ 
ments can be made by promissory notes, one note for each pay¬ 
ment, signed by the party ordering the limb, and also by the party 
offering himself as security, or they can be secured by a letter 
written by the party guaranteeing the payments. The following 
is an example that will be acceptable: 


Place...Date. 

A. A. Marks, New York: 

Dear Sir —Mr. desires to procure from 

you an artificial leg, and wishes to pay for the same in the following 

manner: . dollars will be advanced with the order 

An d .dollars will be paid at the rate of ten dollars 

per month, beginning one month after the delivery of the leg. 

In case of failure to meet the payments as agreed, or in case of 
default due to any cause whatsoever, you may hold me respon¬ 
sible, and upon demand I will pay the same to you. 

Signed . 

Post-office address, . Occupation, . 


Acceptable Guarantors. —We know no mercantile agency that 
quotes the financial standing or business liability of professional 
men, such as ministers, lawyers, doctors, farmers, retired men, em¬ 
ployees, or agents. Mercantile agencies only give the standing of 
credit of those who are actually engaged in commercial or manu¬ 
facturing industries. For this reason, we require the signature of 
a person engaged in business. 











260 A. A. Marks, Artificial Limbs , New York City. 


We believe there are but few dishonest persons; those whose mo¬ 
tives and impulses are entirely void of integrity. Promises are 
made in good faith, but because of inability to keep them, they fre¬ 
quently go by default. A man without means, and being m need ot 
an artificial leg, will assume almost any obligation, in order to pro¬ 
cure one. He has the promise of a situation as soon as he can go 
without crutches. The future is promising and bright. He will 
go to his minister, or to his doctor, or his legal adviser and as a 
rule he will receive his favor. The clergyman or the doctor will 
promise to go security for him. The limb is obtained; the man 
wears it; he gets the situation, and earns fair wages; he becomes 
a little careless in his expenditures, or some relative or friend be¬ 
comes afflicted and requires some financial help from him. lhe 
time arrives for payment to be made, and the young man has no 
money. The minister, or the doctor, who has guaranteed the 
payments, feels that it is unjust to be called upon to make pay¬ 
ments. He writes a pitiful letter, and time is extended, lhis 
is repeated until patience becomes exhausted, and drastic meas¬ 
ures have to be resorted to. It suddenly dawns upon the manufac¬ 
turer that it would be poor policy to force payment out of the min¬ 
ister, or to make enemies with the doctor, and the matter is dropped, 

the manufacturer suffering the loss. 

This is an old, old story, so often enacted in life that the manu¬ 
facturer has been forced to accept no guarantors, except men en¬ 
gaged in business who have acceptable mercantile standings, and 
are prepared to meet losses, should the party default. 

Our Guarantee. —Every artificial leg or arm delivered by us is 
accompanied by a guarantee giving the assurance to the wearer that 
the artificial limb is constructed of the best material, and in a 
thoroughly workmanlike manner, and if any defects present them¬ 
selves, we obligate ourselves to remove them without charge, pro¬ 
vided the limb is delivered to us as soon as the defects have be¬ 
come known, and before the limb has become further damaged on 
account of being worn when out of order. The guarantee covers a 
period of five years from date of delivery. 





CHAPTER XXXII 

PENSIONERS OE THE UNITED STATES ARMY AND 
NAVY FURNISHED WITH ARTIFICIAL LIMBS 
AT GOVERNMENT EXPENSE 

The Original Law— It has been the purpose of the United 
States Government, since the early part of the Civil War (1862), 
to furnish artificial limbs to those who lost their natural ones from 
injuries received while in service. The first law, passed in 1862, 
gave one limb for each amputation, and to soldiers and sailors only. 
It was soon amended so as to include officers. . < 

The Amended Law— In 1870, a new law was passed, which in¬ 
creased the number of those entitled to artificial limbs, and re¬ 
peated the issue every five years.- This law was in force for twenty 
years. 

The New Law Now in Force— In the early part of 1891 Con¬ 
gress enacted additional pension laws, and added to the list hun¬ 
dreds of thousands of soldiers who had never before received 
pensions, and who had never dreamed of receiving any. The same 
Congress adopted measures by which additional benefits were given 
to the beneficiaries of the artificial limb laws. The old law was 
amended so that the issue was changed from five to three years. 
This was done not because soldiers required new limbs so fre¬ 
quently, but as an additional gratuity to the maimed. The law, 

as amended, reads as follows: , 

“ Every officer, enlisted or hired man, who has lost a limb or the 
use of a limb in the military or naval service of the United States 
is entitled to receive, once every three years, an artificial hmb or 
apparatus. The period of three years is reckoned from the last 
maturity subsequent to March 3, 1888.” 

Those whose maturity under the old law occurred between March 
3, 1886, and March 3, 1888, were given a new date: namely, March 
3, 1891 (the day the bill became a law). 

Transportation Free. —Necessary transportation to the manu¬ 
facturer is only issued when the order calls for an artificial limb to 
be made by the government manufacturer who is located the 
nearest to the applicant; if the limb chosen is to be made by a 
manufacturer more distant, transportation will not be given, but 
the order will be issued just the same, provided the applicant is 
willing to have the limb constructed from measurements or will 
pay his own traveling expenses. # 

The Bond. —As manufacturers to the United States Govern¬ 
ment we have met the requirements of furnishing bonds with two 
sureties, of five thousand dollars each, for the faithful perform¬ 
ance of our work. 


261 


262 A. A. Marls, Artificial Limbs , New Yorl City. 


A blank application for an artificial limb and transportation 
will be sent upon request. The same can be filled out, signed, and 
mailed to us. As soon as we receive it, we will ascertain the date 
that the applicant will be entitled to a new limb, and at the proper 
time will pass the application to the proper officials. 

Those who reside at a great distance, and do not care to travel, 
can remain at home and have their limbs constructed and fitted 
from measurements. We extend to them every protection, every 
assurance, every guarantee, and assume every risk, exactly as we 
do to civilians. 

We have on file the measurements, diagrams, records, and dimen¬ 
sions of all the artificial limbs made by us since the founding of 
our house, and can duplicate any limb at any time. 

If a soldier wishes to have a limb duplicated, he will not be re¬ 
quired to send any additional measurements. 

We advise pensioners to procure artificial limbs under the laws, 
and apply for them promptly upon the maturity of their claims, 
and lose no time. 

When Congress makes changes in any law, the law in force up 
to that time becomes null and void. No one can predict what Con¬ 
gress will do, any more than he can predict what public sentiment 
will be on any issue. Should a party clamoring for extreme econ¬ 
omy in the administration of public affairs become dominant, there 
is no telling what would be done in cutting down allowances. 

Advantages in Kegistering with Us. —As pensioners seldom 
keep records concerning themselves, we make it a point to notify 
them a little prior to the date of their maturity. Any change, or 
threatened change, in the law affecting the issue of artificial limbs 
is watched by us and communicated immediately to those on our 
records whom the law may affect. It is, therefore, to the advantage 
of the pensioner to keep within touch of us; to inform us of his 
change of address, and to see that our records are complete, so far 
as rank, company, regiment, number of pension certificate, etc., 
are concerned. 

Those Amputated in the World War. —Those amputated 
through injuries or other causes in the World War are entitled to 
artificial limbs, supplies, socks, suspenders and all other appur¬ 
tenances as frequently as they are needed. The issuing of orders 
for artificial limbs as well as supplies is invested with the Veterans 
Bureau of the Public Health Service. This service has centers in 
many places in the United States. Each beneficiary is required to 
apply to the Bureau nearest to him. Present himself for examina¬ 
tion and if his needs are actual the Bureau will issue an order on 
any artificial limb maker for such requirements. 



CHAPTER XXXIII 

CHEAP ARTIFICIAL LIMBS 


From the International Journal of Surgery 

Cheaply Made Limbs Not Safe. —From time to time the news¬ 
papers chronicle severe accidents happening to the wearers of ar¬ 
tificial limbs as the result of faulty construction. Here is an in¬ 
stance taken from the Cincinnati Enquirer of December 19, 1901: 

“Fred Rentz was severely injured last evening, about five 
o’clock, by falling on the street at Central Avenue and Liberty 
Street. His fall was due to a cork leg breaking„ The unfortunate 
man was taken to a hospital by Patrol No. 5.” 

Inviting Disaster. —There is material in this brief item for 
profound thought on the part of every man who has occasion to 
require an artificial leg. There is material, too for a sermon on 
the iniquity of dealers who sell artificial limbs of inferior or 
defective workmanship. That there are many persons who com¬ 
mit the folly of risking their bodies, and possibly their lives, upon 
poorly made limbs for the sake of the few dollars saved thereby, 
and that there are dealers who are willing to encourage them in 
this folly, may be proved to the satisfaction of anyone who will 
read the daily papers carefully. Every few days cases are re¬ 
ported similar to the above, and in almost every case the disaster 
may be traced to the same cause—poor material or inefficient work¬ 
manship. 

Mr. Rentz undoubtedly wore a cheap leg—cheap in construction, 
but very costly in the price he ultimately paid for it in money, 
suffering, and lost time. Some weakness in the wood or leather or 
steel (there is no cork in any artificial limb) was revealed by an 
accidental slip which brought an unusual strain upon it, and caused 
it to give way just when he had most need to rely upon it. The 
saying that “ no chain is stronger than its weakest link v applies 
with the fullest possible force to an artificial leg. Every part may 
be perfect except one, and yet that one is certain to precipitate a 
fall of serious if not fatal results. 

The adage that “the best is the cheapest” applies to almost 
everything that one may require. It applies without exception 
to the purchase of artificial limbs. The steeplejack will not make 
use of a cable unless he knows that it has been tested and proved 
to be capable of sustaining the weight that he will bring to bear 
upon it. The caisson worker will not descend below the bed of a 
river unless he is assured that the air-pumps are in perfect working 
order. No more should the wearer of an artificial limb trust him- 

263 


264 A. A. Maries, Artificial Limbs, New York City. 


self upon it unless proved material, skill, and honesty have entered 
into its construction. 

Confidence Necessary to Success. —The essence of success in 
walking with an artificial leg is confidence. To learn to manipu¬ 
late the limb is a very simple matter, but unless the wearer knows 
i';hat he can rely upon it as thoroughly as he would upon his natural 
legs he will never be able to walk well or to move about with a sense 
of perfect freedom. There are thousands of persons walking about 
to-day on Marks’ artificial legs whose intimate friends are not 
aware that they have lost any of their natural members. They do 
saot limp or hobble, and they do not find the slightest difficulty in 
moving about as freely as their most active neighbors—all because 
they have confidence; they know that every bit of material that 
enters into the leg is carefully tested and proved before it is used, 
and that, therefore, it cannot possibly give way under ordinary use 
or at some critical moment when they most need its support. 

A vast amount of care and trained ability enters into the con¬ 
struction of a thoroughly reliable artificial leg, foot, or arm. It 
will not be sufficient to use ordinary material, or even the best 
material that can be bought through the ordinary channels of trade. 

Selection of Material. —As the first step in the manufacture of 
the artificial leg, an expert visits the woods and selects the tree 
from which the material is to be cut. To do this is no easy 
matter, and requires long experience. The tree must be neither 
too young nor too old. It must be free from knots and must have 
a firm, even grain that it will be equally strong in every part. 

When the tree has been felled it must be cut into lengths and 
carefully split into sections, use being made only of the main body 
of the tree trunk in which the grain is firm and even. Only a small 
portion of the ordinary tree is available for this purpose. 

When the wood has been thus carefully selected, it is by no 
Tneans ready for use. It must then be kiln-dried, so as to be 
thoroughly shrunk before it can be utilized. About four years is 
required in this process before the stick of timber can be manu¬ 
factured into an artificial leg. 

It is not the wood alone that is selected with such careful atten¬ 
tion to its strength and wearing qualities. The steel which goes 
to form the braces and joints of the leg is first carefully tested to 
detect the existence of any flaws or defects and to prove that it is 
capable of carrying a larger weight than it will be called upon to 
support. 

The leather for the jacket which forms the upper part of the 
leg is selected with equal care. Only the strongest and most 
valuable parts can be used; the rest must be thrown away or used 
for some other purpose. The buckskin lacings are also a matter of 
solicitude, and are subjected to thorough tests to determine the 
weight they will sustain. 

Even a more delicate matter is the proper vulcanizing of the 
rubber foot which plays an important part in every successful 
artificial leg. The elasticity of the foot depends upon the exact 



A. A. Maries, Artificial Limbs, New Yorlc City. 265 


degree of heat applied to the rubber. Thus, at every step in the 
selection of material, the greatest care and judgment must be 
exercised. 

The need of practical experience and expert judgment does not 
end with the selection of materials. Equal skill is needed to 
assemble them properly. An artificial leg, to be a source of com¬ 
fort and usefulness to its wearer, must fit perfectly, and no two 
persons can be fitted by exactly similar legs. The highest skill of 
the artisan is required to meet and make allowances for all the 
little peculiarities of each individual wearer. It is ridiculous to 
assume that it is possible to fit all comers with artificial legs simply 
by carrying a few sizes in stock. 

The worst mistake that the prospective purchaser of an artificial 
limb can make is to patronize one of the cheap establishments 
which are continually being started by disgruntled apprentices or 
discharged workmen. It seems incredible that a man who will not 
permit his horse to be shod by an incapable blacksmith, or his 
beard to be trimmed by a man of no experience as a barber, will 
nevertheless trust the delicate and vital task of supplying an 
artificial limb for himself or a member of his family to a crude 
bungler or a cheap mechanic. Yet such cases come to notice 
frequently. Too late, when permanent injury has been done to 
some delicate blood vessel or tender nerve center, or when a bad 
fall and broken bones have taught the lesson that better counsel 
might have imparted in the beginning, he turns to the firm that 
has a long-established reputation for efficiency, reliability, and 
honest dealing. 

How much better—yes, how much cheaper—it would be to in¬ 
trust one’s self in the beginning to a firm the members of which 
have gained a thorough knowledge of the subject through a business 
experience of years, which spares no expense to secure the most 
perfect materials for its artificial limbs, which employs the most 
carefully trained and thorough workmen, which owns the most 
important and successful patents for artificial limb appliances, 
and the name of which is a guarantee of good faith, good work¬ 
manship, and satisfaction to its customers! 



CHAPTER XXXIV 

DO THE MAIMED DIE YOUNG? 

A False Belief. —There appears to be a belief, shared by the 
medical profession as well as the laity, that the amputation of one 
or more of the limbs from the human body necessarily curtails the 
allotted years of man, that there is a law that establishes a ratio 
between the length of the life of the normally equipped man and 
that of the dismembered one. That the ratio is according to the 
extent of the dismemberment. If a man is born to live three 
score and ten years, provided he retains all his limbs, the loss of 
one limb will take, say, ten years from that allotment; and if he 
loses two limbs the lopping off of a few more years will be the 
consequence. 

What Our Records Disclose. —During our career as protheti- 
cians we have had opportunities to investigate. An examination 
of our records, which comprise the histories of many thousands of 
maimed persons, has led us to the conclusion that the dismembering 
of the human body plays no part whatever in shortening life. Our 
records date back to 1853, and it is a fact that, of the entire num¬ 
ber of our patrons, less than twenty-five per cent, have died, and 
most of those have died from old age or accident, and in no case 
can we learn of a death that can be directly ascribed to the loss of 
a limb. We know of very few persons wearing artificial limbs who 
have suffered or died from pulmonary or cardiac diseases, and those 
who have fallen under those diseases were affected before their 
limbs were amputated. It is not an uncommon occurrence for 
octogenarians who have been our patrons for years to order new 
limbs, expecting to live long enough to wear them out. 

Amputations Revitalize the System. —As we investigate this 
subject more thoroughly we are persuaded that amputations re¬ 
vitalize the entire person, and render it not only possible but 
probable, that, on account of amputations, the lives of the subjects 
will be prolonged, comparatively immune to disease. 

It is obvious that diseased and mangled limbs that cannot be 
cured will cause death if they are not removed; but this is not the 
phase of the question we are discussing. Will the length of life 
of the person who has had his limb removed on account of disease 
or injury be less than it would had his limb never been diseased, 
injured, and amputated? While it is absolutely impossible to give 
a direct reply to this question we believe, and we say it with all 
sincerity, that the compensation for the loss of a limb lies in 
assured good health and prolonged life. Numerous instances sup¬ 
port this belief and many of them are of national reputation. 

266 


A. A. Marks, Artificial Limbs, New York City. 267 


Illustrations. —Rev. Edward Beecher reached the age of eighty- 
four. Evidences of senility were apparent. By making a false 
step he fell from a railroad train and had one of his legs so badly 
crushed that it had to be amputated. He recovered from the opera¬ 
tion and had an artificial leg applied. He lived for eight years and 
enjoyed excellent health and remarkable physical strength and 
mental energy. It was his custom to take long walks every day, 
to preach sermons on Sundays, lead prayer meeting during the 
week, and in fact, perform all the duties expected of a clergyman. 
From the moment he recovered from the accident that deprived him 
of his leg, new life and renewed energy came to him. He was a 
stronger, healthier, and more sprightly man after the accident than 
he had been for a number of years prior to it. 

Governor Wade Hampton lived to be an octogenarian. He had a 
leg amputated a number of years before and wore an artificial one 
up to the time of his death. He was up to the last moment mentally 
and physically strong. 

John Pearson lived to be eighty-five years of age. He lost a leg 
when seventy, recovered quickly, obtained an artificial leg, enjoyed 
vigorous health, giving his time to his railroad interests almost up 
to the moment of his death. General Butler, General Wager 
Swayne, and scores of others have more than fulfilled the biblical 
allotment and enjoyed many years of active life after having been 
deprived of one of their limbs. 

It is a remarkable fact that there are very few maimed persons 
in insane asylums. Records of suicides are almost free of the 
crippled. The mental as well as the vital forces appear to become 
stimulated by the dismemberment. 

Athletes. —Dare, Melrose, Conway, Leland, and Fitzpatrick are 
one-legged acrobats whose muscular developments are the envy of 
the world. Few possessed of natural limbs can vie with them in 
athletic activities. 

It is a noticeable fact that persons who lose their legs become 
powerful in their arms, large in chest and girth, and persons who 
lose their arms become powerful in their legs and large in girth. 
The loss of one part of the body stimulates the growth of the re¬ 
maining parts. . _ , , . 

Compensation. —A reasonable explanation may be round in tne 
hypothesis that the removal of a part of the body lessens the de¬ 
mand on the vital forces and permits the supplying reservoirs to 
contribute more abundantly to the remaining members. If it over¬ 
taxes the heart to force the blood through all the avenues of the 
body, will not its labors be lessened if some are cut off? And 
will not the remaining avenues receive a larger share of the life- 
giving essences? If the nervous system is taxed to its limit, will 
not the tax be lessened if a part of the nerve organization be re¬ 
moved? If a tree is permitted to grow unpruned, it will sap itself 
by many choking branches and the trimming up of the limbs 
always gives vigor. The tree will grow larger, stronger, and will 
live longer. 



268 A. A. Maries, Artificial Limbs, New York City. 


It has been said that a maimed person takes care of himself, does 
not expose himself to the elements, or to the dangers that beset other 
human beings; that on account of being crippled, he is compelled 
to be more cautious than others; he cannot indulge in the riotous, 
inebriate course which wrecks so many lives. In this connection 
we will say, and we speak from knowledge, that a person who is 
deprived of one or more of his limbs is not necessarily a convert 
to a life of virtue. He is not always the sober man, the epitome 
of morality that some persons think he is. He goes through life 
in the same careless manner as other healthy mortals, doing what 
he ought to do, and many times what he ought not to do. He 
sometimes observes propriety, but oftentimes is as reckless as his 
companions. There are, however, many maimed persons who are 
sober, industrious, thoughtful, and prudent. The same habits, 
indulgences, and discretions that are found among those in posses¬ 
sion of their natural limbs are found in about the same proportion 
among those who have been amputated. 

Gratitude. —It is also an error to suppose that the loss of a 
limb induces despondency. There will not be found a class of 
people who are less lugubrious and who lament their losses as little 
as that class of humanity having abbreviated extremities. We 
recall the visit of a man some years ago who had both of his legs 
and one arm amputated. After reciting a harrowing tale of a 
railroad collision and fire, weeks of suffering at the hospital, and 
his recovery to health with only one of his four limbs remaining, 
he closed his narrative with the ejaculation: “ Thank God, it was 
no worse! ” This illustrates fairly well a crippled man’s disposi¬ 
tion. He is more thankful that he has not lost more, than he is 
regretful for having lost so much. He is constantly meeting with 
persons who, in his mind, have met with greater hardships than 
himself. It is an ordinary occurrence for a one-legged man to 
meet a one-armed man, and for each to say to the other, “ I prefer 
to be as I am rather than as you are.” 

A cripple is neither a cynic nor a pessimist. His misfortunes 
have driven from him whatever there may have been of the choleric. 
Being always in good health, he is a happier and a more contented 
man than the dyspeptic, the rheumatic, or the gouty man, who is in 
possession of all his limbs. It is a common occurrence for a man 
wearing two rubber feet to take consolation from the fact that he 
can never be troubled with corns, gout, or suffer the torture of hav¬ 
ing some ponderous lout tread on his feet. : 

Nature, with her usual generosity, compensates for every mis¬ 
fortune. We look about us and see conditions that are appalling, 
and are impelled to pour out our commiseration; but we little think 
how useless, how unsolicited, and often uncharitable it is for us 
to do so. Those that are the most afflicted need our commiseration 
the least. Their minds and dispositions have already been prepared 
by Nature to bear their misfortunes, and they dislike to have others 
notice or mention them, much less to shed tears over that which 
they so little regret themselves. 



CHAPTER XXXV 

AWARDS 

1858. The first Exposition at which A. A. Marks exhibited artifi¬ 
cial limbs was at the Crystal Palace at New York in 1858. As 
that exhibition was destroyed by fire no awards were given. 

1859. American Institute, New York City.— The silver medal 
was awarded to A. A. Marks for his superior artificial limbs. 

1865. American Institute, New York.— After a. careful and 
extended examination, and practical tests of the various kinds of 
artificial limbs, the First Premium Gold Medal was awarded to A. 

1867. American Institute, New York, Eirst Premium. —Marks’ 
Patent Artificial Limbs have frequently been before the Institute 
and continue to sustain their former reputation. The First 
Premium awarded. 

1869. American Institute, New York.—A. A. Marks Rest. 
This limb is constructed with an india-rubber foot, which from 
its elasticity does away with the necessity of motion at the ankle, 
and also obviates entirely that heavy, thumping sound when the foot 
strikes the ground in walking. The control which the wearer has 
over it and its movements, so closely resembling those of the 
natural limb, entitles it to the highest commendation. First 

Premium awarded. ^ . 

1870. American Institute, New York. —The especial point ot 

excellence appears to be the rubber foot, by the. use of which all 
complications in the construction of an ankle joint are avoided. 
First Premium awarded. , 

1871. American Institute, New York. —The artificial limbs with 
rubber feet and rubber hands are especially recommended for their 
simplicity, durability, and easy movements. First Premium 
awarded. 

1872. American Institute, New York. —The artificial limbs 
manufactured by A. A. Marks continue to merit approval, and are 
entitled to all the confidence the public have reposed in them. 
First Premium awarded. 

1878. American Institute, New York. —After full and impartial 
examination of the articles above described, the undersigned Judges 
make report that they find the artificial limbs on exhibition by 
A. A. Marks worthy of the confidence heretofore reposed m them. 
We cheerfully indorse all that has been said of them by former 
examiners, their simple construction , easy movements , dura¬ 
bility, etc. First Premium awarded. 

1874. American Institute, New York.— We consider the arti¬ 
ficial limbs of A. A. Marks of great value. A great improvement 

>;69 





270 A. A. Maries , Artificial Limbs , New York City . 


—better than any known to us; and entitled to the highest award. 
First Premium awarded. 

1875. American Institute, New York.— We regard the artificial 
limbs presented by Mr. Marks superior to all others in practical 
efficiency and simplicity. First Premium awarded. 

1876. Centennial Exhibition, Philadelphia, Pa.— The Judges 
having examined Marks’ artificial limbs respectfully recommend 
the same to the United States Centennial Commission for the 
highest award, for the following reasons, viz: Utility, Workman¬ 
ship, and Adaptation to Purposes Intended. Highest award given. 

1876. American Institute, New York. —The judges consider 
the limbs made by A. A. Marks remarkable for simplicity of con¬ 
struction, durability, efficiency, and comfort to the wearers. 
Special Gold Medal awarded. 

1877. American Institute, New York. —After a full and im¬ 
partial examination of Marks’ artificial limbs, the Judges report 
that they consider the exhibit of great value and entitled to highest 
award. Medal for Superiority awarded. 

1878. American Institute, New York. —Having received the 
Medal of Superiority in 1877, The Diploma for Maintained 
Superiority is awarded at the Exhibition of 1878. 

1881. International Cotton Exposition, Atlanta, Ga.—F irst 
Premium, Gold Medal, awarded for the following reasons: 

First. Simplicity in the mechanism of the knee joint and its 
excellent movement. Second. Durability. Third. Rubber Foot, 
possessing many excellent qualities and compensating for the 
absence of the motion in the ankle joint. The highest award was 
declared in favor of A. A. Marks. 

1885. The World's Industrial and Cotton Centennial Exhibi¬ 
tion, New Orleans, La. —The Jurors having carefully examined 
the exhibits of artificial limbs concur in recommending the award 
of the First Class Medal to A. A. Marks, New York. Gold Medal 
awarded. 

1889. The John Scott Legacy Premium and Medal. —John 
Scott, late of Edinburgh, by his will made in the year 1816, be¬ 
queathed a sum of money to the Corporation of the City of Phila¬ 
delphia, directing that the interest and dividends received there¬ 
from shall be laid out in premiums, to be distributed among in¬ 
genious men and women who make useful inventions, and that 
therewith shall be given a medal with this inscription: 

“ To The Most Deserving.” 

The great improvements in artificial limb construction consist 
in the substitution of rubber for wood in both the foot and hand. 

The rubber foot consists of a wooden block rigidly secured or 
formed with the leg and extending downwardly to within about two- 
fifths of the distance from the ankle to the sole, and forward to 
nearly the first articulation of the metatarsus and toes; this block is 
covered with india-rubber. 

The action of such an artificial foot is that of an elastic segment 



A. A. Maries , Artificial Limbs , New Yorlc City. 271 


of a wheel. The shock of placing the weight upon the heel at each 
step is avoided by the elastic cushion of rubber forming the heel, 
and as the weight is progressively transmitted to the forward part 
of the foot, by the combined effect of muscular exertion in the re¬ 
maining part of the natural limb, and the momentum previously 
acquired, an easy flexure of the toes takes place, which, reacting 
elastically as the weight is transferred to the other limb, giving an 
easy and naturally appearing movement. Such artificial feet are, 
upon trial, found to be easier to use, lighter, and more comfortable. 

The desire to adapt the india-rubber hands to changes of flexure, 
for purposes of better and more natural appearance and to grasp 
light objects, led Mr. Marks to improve them by making a light 
wooden core in the palm or metacarpal portion of the hand and 
inserting ductile metallic wires in such core, which extended 
centrally through the fingers. By bending the fingers they retain 
the form in which they are set. 

The latest improvement in artificial limbs consists in forming 
the leg and foot part of a single piece of wood, having the grain 
curved naturally in its growth, such pieces being procured from the 
parts of the trunk contiguous to the roots and branches of trees; 
limbs made in this way are stronger with the same amount of wood 
remaining in them than when made of parts glued together, and are 
made waterproof, which is a valuable feature when the occupation 
of the wearer exposes it to constant dampness, or to water itself, 
as in fishing, mining, dredging, etc. 

The above report was presented to the committee appointed by the 
City of Philadelphia, under the auspices of the Franklin Institute, 
and it was unanimously decided that the John Scott Legacy Medal 
and Premium be awarded to A. A. Marks. 

1891. Augusta Exposition, Augusta, Ga—S even Gold Medals 
and Awards for distinct and separate features of excellence. 

First. For Improved Artificial Legs with Rubber Feet. 

Second. For Improved Artificial Arms with Rubber Hands. 

Third. For Superior Methods of Suspenders for Artificial Legs 


and Arms. „ . ... . * 

Fourth. For Superior Crutches and other Auxiliaries tor 

Cripples. „ . , 

Fifth. For a Combined Knife and Fork for the use of one-armed 

^Sixth. For Improved Waterproof Artificial Legs, carved from 
natural crook timber. 

Seventh. For Improved Artificial Legs and Arms with Alu¬ 
minum Sockets. , . . 

1893. The Elliott Cressons Gold Medal, awarded to A. a. 
Marks for aluminum socket artificial legs and arms, as stated in 

the following report: . , ,, A , 

At the stated meeting of the committee on Science and the Arts 
of the Franklin Institute, held February 1, 1893, the following re* 
port was adopted and ordered to be issued : 

This invention consists of an improved method of making arti 



272 


A. A. Marks, Artificial Limbs, New York City 


ficial limbs, adapted to amputations in the ankle, or below, in the 
tarsus or metatarsus, in which the former modes of construction, 
with articulated ankle joints of wood as the material, were im¬ 
practicable and unsatisfactory. The new method of construction 
involves the use of aluminum as the material to form the shell 
socket or sustaining frame, as it might be called, the aluminum 
shell supporting the body, and forming the attachment for the 
elastic rubber foot, which acts as a rolling elastic segment simulat¬ 
ing the functions of the natural foot in walking, and acting as an 
elastic cushion in relieving the wearer from the jar or shock of 
resting the weight upon the limb. 

Your committee has examined the limbs in the course of manu¬ 
facture, and as completed and as in use by wearers. When clothed, 
they give no indication in walking that they are not natural feet. 

It is clearly apparent that the invention is one affording much- 
needed relief to persons heretofore greatly embarrassed, and 
further that the surgeons may save much more of the patient’s body 
from mutilation than heretofore, and yet render comfortable and 
satisfactory artificial limbs practicable. 

In view of these points of excellence and well-attested evidence 
thereof the committee awards the Elliott Cresson Medal to Mr. 
Marks, of New York. 

1893. World's Columbian Exposition, Chicago. —The judges ap¬ 
pointed to investigate artificial limbs decided in favor of Marks’ 
artificial limbs and recommended to highest award on the following 
points of excellence. 

First. Kubber Foot. ( a ) Its close approximation to the mo¬ 
tions and actions of the natural foot. 

(b) Its durability and lightness; the yielding and elastic quali¬ 
ties of rubber supply requisite motion without necessitating mech¬ 
anism. 

( c ) Phalangeal assistance. The methods of construction and 
connection with the body of the leg in each case are such as to 
provide assistance in walking from the anterior portion of the foot, 
at the same time maintaining the height of the wearer when walk¬ 
ing, same as is obtained from the natural foot; the feature of 
phalangeal assistance avoids limping, and removes the fear of top¬ 
pling forward when standing. 

( d ) The elasticity of rubber affords a yielding medium to alight 
upon, thus avoiding jars and concussions to the stumps. 

Second. —Knee Joints, (a) The construction of knee joints is 
such as to render them capable of adjustment, thus obviating the 
noise that follows attrition. 

( b ) The disposition of the knee spring, which assists extension 
of the lower leg, is such as to become neutralized when the leg is 
flexed to a given angle; this avoids “ kicking out ” of the lower leg 
when the wearer is sitting and unguarded. 

(c) Safety lock. This attachment is combined with the knee 
mechanism, and provides against treacherous flexing of the knee, 
thus avoiding dangerous falls. 



A. A. Marks, Artificial Limbs, New York City 


273 


Third. The production of waterproof legs from natural crook 
timber with rubber feet attached. 

Fourth. Aluminum sockets, especially designed for stumps that 
extend to the ankle and in the body of foot. 

The advantages obtained by the utilization of this metal are as 
follows: 

(a) The production of a socket that can be closely fitted to the 
stump, without touching or allowing painful contact with any of 
the tender spots on the stump, at the same time possessing suf¬ 
ficient strength to properly support the wearer. 

( b ) The construction of a socket that will possess the requisite 
strength without conspicuously enlarging the ankle. 

Fifth. Roller Suspenders. The object of this method of suspend¬ 
ing an artificial leg to the wearer is to avoid the moving and rub¬ 
bing of the shoulder straps on the shoulders. 

First. The Rubber Hand, (a) Being composed of rubber, is 
pleasant and natural to the touch and durable in construction. 

( b ) The fingers, being ductile, can be placed into accommodating 
positions. 

( c ) The palm of the hand, being provided with a locking socket, 
is capable of holding implements of utility with firmness. 

Second. The ability to detach the hand at the wrist for laboring 
purposes. 

Third. Rotation of hand at wrist. 

Fourth. The elbow joint, with lock for holding the arm in a 
flexed position. 

Fifth. Fingers and parts of hands made of rubber. 

Sixth. Rotation of upper arm socket. 

In conformity with the Judges’ report, the highest award (medal 
and diploma) was declared in favor of A. A. Marks, New York 
City. 

Two additional diplomas were awarded by the Board of Lady 
Managers, one for Design, and the other for Invention. 

1895. Cotton States and International Exposition, Atlanta, 
Ga. —This certifies that the appropriate jury has awarded to A. A. 
Marks of New York City the Gold Medal “For the most complete 
exhibition of ingenious mechanics for the relief of physical defects 
and deformities, namely: Artificial Legs, Rubber Feet, Artificial 
Knee Joints, Self-Adjusting Suspenders, Artificial Arms, Rubber 
Hands, Duplex Elbow Joints, and Aluminum Socket Legs; also for 
Imitating the Movements of Knee, Elbow, Wrist, and Finger 
Joints.” 

1896. American Institute, New York. —After a full and im¬ 
partial examination the Judges made report: 

That the exhibit of A. A. Marks of artificial limbs, deserves the 
highest award for the following reasons. 

First. To the rubber foot with imbedded metallic mattress spring. 

Second. To the flexible fingers on artificial hand, and their great 
adaptability to everyday use. 

Third. The use of aluminum in place of wood for climatic varia- 



274 A. A. Maries , Artificial Limbs , New York City. 


tions seems to be of practical use for those engaged in certain em¬ 
ployments. 

Finally, the ingenious combination Knife and Fork for the one- 
armed is highly commended. The medal of superiority was accord¬ 
ingly awarded. 

1897. Tennessee Centennial and International Exposition, 
Nashville, Tenn. 

The highest and only award for artificial limbs was given to A. 
A. Marks of New York. 

The merits that received especial recognition were: Artificial 
Legs with Rubber Feet, Adjustable Knee Joints, Artificial Arms 
with Rubber Hands, and a Combination Knife and Fork for one- 
armed persons. 

1898. Trans-Mississippi and International Exposition, Omaha, 
Neb. Diploma and Gold Medal awarded to A. A. Marks, New 
York. 

Marks’ Artificial Legs with Rubber Feet and Artificial Arms 
with Rubber Hands are superior to all others in the following 
points: 

Excellence of mechanical construction. 

Minimum weight, maximum durability. 

Noiselessness. 

Motions that simulate nature. 

Knee joints, adjustable and noiseless. 

Suspenders, of variety adaptable to every condition. 

Knee lock for short and enervated stumps. 

Fittings that permit pressure at points of toleration; avoiding 
impact on the vascular parts, thereby preventing choking of blood 
vessels. 

Rubber hands with ductile fingers, most accommodating and 
possessing the greatest range of utility. 


1900. Exposition Universelle de Paris, France. 

A. A. Marks, New York. 

Dear Sir: — I am instructed by Commissioner General Peck to 
inform you that you have been awarded the 

. (GRAND PRIX) Grand Prize 


for your exhibit in Class 16 at the International Exposition, Paris, 
1900. 


Respectfully yours. 


J. H. Gore, Juror-in-Chief. 


In competition with nearly fifty manufacturers from all parts 
of the world, A. A. Marks won over 20 POINTS OF MERIT, 
thereby earning the ONLY GRAND PRIZE FOR ARTIFICIAL 
LIMBS. 

1901. Pan-American Exposition, Buffalo, N. Y. The points 
of merit and claims for superiority presented to the Board of 
Jurors, as follows*: 



A. A. Maries, Artificial Limbs , New York City. 275 


First. The rubber foot with spring mattress. 

Second. Knee joint with adjustable bearings and removable 
bushings. 

Third. Hip joint for hip-joint amputations. 

Fourth. Knee lock for short and enervated stumps. 

Fifth. Suspenders arranged to minimize the burden and tax 
on the shoulders. 

Sixth. Aluminum sockets for ankle-joint and partial foot ampu¬ 
tations. 

Seventh. Rubber hand with ductile fingers and palm attachment 
for holding implements. 

Eighth. Wrist joint admitting of rotation, displacement of the 
hand and substitution of laboring implements. 

Ninth. Elbow lock, holding arm in flexed and other positions. 

Tenth. Humeral rotation, admitting the arm to rotate above the 
elbow joint, so that when flexed it can be brought closer to the 


person. 

Eleventh. Artificial hand for partial hand amputation. 

Twelfth. Artificial legs for bathing purposes. 

Thirteenth. Artificial arms that are absolutely waterproof. 
Fourteenth. Combination knife and fork designed for persons 
who are temporarily or permanently disabled in one hand. 

Upon these points of merit the Gold Medal and Diploma were 

awarded to A. A. Marks. ^ 

1902. South Carolina Inter-State and West Indian Exposi¬ 
tion, Charleston, S. C. Gold Medal awarded to A. A. Marks, 
of New York, for artificial legs and arms of superior construction. 

1904. The Louisiana Purchase Exposition (World's Fair), 
St Louis, awarded to A. A. Marks, of New York, the only GRAND 
PRIZE for ARTIFICIAL LIMBS, the highest award given to any 


exhibit in any department, . 

The Grand Prize at St. Louis following the Grand Prix at Pans. 
1900, prove beyond controversy the superiority of Marks’ artificial 
legs/feet, arms, and hands, and the maintenance of their excellence 
not only in America, but throughout the entire world. 

1905. The Lewis and Clark Centennial Exposition, Portland, 
Oregon, awarded two Gold Medals (highest awards) to A. A. 
Marks, New York, manufacturers of the celebrated artificial limbs 

with rubber feet and hands. . , , , 

1907 New Zealand International Exhibition, Christchurch 

New Zealand, November, 1906, to April, 1907 . The highest award 
of merit, Gold Medal, to A. A. Marks, New York, U. S. A., Arti- 

^WOr'^AMESTOWN Exposition, Norfolk, Va., April 26th to No¬ 
vember 30th. The highest award Gold Medal to A. A. Mar s, 

^fi^“lON, Auckland, New Zealand-First and 
Special Diploma and Gold Medal to A. A. Marks, New York, Arti- 
ficial Limbs. 



276 A. A. Marks, Artificial Limbs, New York City. 


1915. Panama-Pacific International Exposition, San Francisco, 
California—Highest Award to A. A. Marks, New York, Artificial limbs 
with rubber hands and feet. 



V 


CHAPTER XXXVI 

TESTIMONIALS 

It would not be an exaggeration to say that we receive annually 
over a thousand letters bearing testimony of the excellent qualities 
of our products. To print these letters would mean a publication 
of huge proportions and so prolix as to be wearisome. 

We have, heretofore, printed and illustrated extracts from testi¬ 
monials, adding thereby many pages to our manual. But we are 
now departing from that method, and are listing the writers in a 
way that the readers can select men or women whose occupations, 
ages and peculiarities of amputations may interest them mostly. 
This arrangement not only economizes space but makes it possible 
for the reader to select cases that are like his own. It also proves 
the many contentions that are claimed for the superior quality of 
our artificial limbs. 

The reader can select as many names as he chooses and send 
them to us. We will immediately furnish the most recent addresses 
we have. This will enable the reader to call upon or communicate 
with whomever he wishes. 

Persons wearing artificial limbs move about the same as those in 
possession of their natural extremities. They change their ad¬ 
dresses and fail to inform us and sometimes fail to inform their 
own post-offices, therefore letters are returned with stamp, “ Moved 
to Parts Unknown.” The reader must not be disappointed if his 
inquiry meets with the same fate. We are powerless to correct it. 

Sincerely yours, 

A. A. MARKS. 


277 


CHAPTER XXXYII 


CONTENTIONS 

lsf Contention 

MARKS ARTIFICIAL LEGS AND ARMS ARE SUPERIOR: 

Robert Haak writes the “ Marks Leg is the best he ever wore ”; he had 
worn many other makes. Dr. C. J. Hamilton writes: “ There is no other 
firm that gives such successful results as you do.” Edward Harris 
writes that the two other legs he had worn were a waste of money, 
“ Marks Leg the best” Archer R. Johns, also John Peters and many 
others write that as an experiment they had the wooden feet of their old 
artificial legs removed and rubber ones put on, eliminating ankle mo¬ 
tions, and were benefited by the substitution. Dr. C. S. Judy writes that 
“ Marks Leg is the best because it is simple in its construction and in 
its adjustments.” F. M. Kelleher wore a Marks Leg, then tried a slip 
socket, was disappointed and returned to the Marks, which he has worn 
since. John T. Rice states that with all other artificial limbs he had 
worn, he suffered from chafed and irritated stump, the Marks Leg 
gave him relief, not so much on account of better fitting, but the fact 
that the rubber foot avoided jar in walking, which he always felt with 
the wooden foot. J. F. Baldridge wore two Marks Legs, then got one 
with wooden foot, finds the Marks the best. E. George Moses writes 
that the leather sockets of other make artificial limbs caused irritation 
to his stump, but the firm willow socket of the Marks Leg being smooth, 
did not allow friction, therefore his stump was not irritated and he 
wears the Marks Leg with more comfort. J. G. McIntyre writes 
that he earns more wages with the Marks Rubber Foot Leg than he 
did before he got one. Abelardo Lopez of South America writes that 
the Marks Leg is light and strong, therefore better than any other 
he had worn. M. C. Gallo writes that the fingers of the wooden hand 
he had formerly used were always breaking, but that the fingers of 
the Marks Rubber Hand never broke. 

It may interest the reader to find so many commenting on the ad¬ 
vantages of the rubber foot without ankle motion in propelling bicycles. 

A. M. Caldwell, Rev. J. H. Kent, Theo. M. Keough, C. B. Kingsley, 
A. F. McNaughton, J. R. Malcolm, H. E. Martin, C. B. Metcalf, A. E. 
Oakes, Luis Restrepo, John T. Rice, Gabriel Perez Rivero, Mrs. B. J. 

Shurtleff, Joseph Smith, E. W. Spedding, H. C. Temple, Charles Wilkin. 

* 

2nd Contention 

MARKS ARTIFICIAL LEGS AND ARMS ARE DURABLE AND 
STAND THE HARDEST AND LONGEST SERVICE: 

It is interesting to know how many have worn Marks Artificial Legs 
and Arms for scores of years and speak of their durability and efficiency 
for long, continuous service. Some of the statements are hardly credible, 
but investigations prove their truthfulness. 

The simplicity with which the Marks Artificial Legs and Arms are 
constructed makes it possible for them to last a lifetime, even if the 
wearer reaches advanced years. There is practically nothing to get 
out of order and when worn by persons of mechanical minds the at- 

278 


A. A. Marks, Artificial Limbs, New York City. 279 


tentions that may be needed from time to time are given by the wear¬ 
ers themselves. 

Mrs. William J. Bryan writes what little repairs her husband’s 
artificial leg, which he has worn continuously for 14 years, has required, 
he has always made them himself. Many similar letters can be found 
in the list. 

We give below a list of writers who are among our oldest living pa¬ 
trons. Those who wish to be assured of the durability of our limbs 
will find much to think over in their letters. This list contains only 
those who have worn Marks Limbs for over twenty years. There are 
nearly one hundred other letter writers who have worn them from ten 
to twenty years. A considerable number state they have only worn 
one artificial limb during the period mentioned, a few state that they 
have had renewals. 

William Griffin writes he has worn Marks Limb for 51 years, John 
Matthews for 50 years, Dr. R. T. Taggart 48 years, J. G. Shirk 46 
years, D. M. Green 45 years, Henry F. Hicks 45 years, George F. 
Morse 45 years, E. A. Gallup 43 years, Silas W. Fickel 40 years, M. 
Parrage 40 years, E. O. Rentz 40 years, Edw. E. Bownes 39 years, John 
H. Valentine 39 years. Jose Baquero writes: “The leg you sent me 38 
years ago is being worn yet.” A. W. Mills 38 years, Isaac Post 
38 years. Dr. E. P. Rice states his father has worn a Marks Leg for 38 
years, Jose Estevez 34 years, J. J. Booth 33 years, W. J. Bray 33 
years, Dr. C. E. Smith 33 years, George Hy. Barstow 32 years, George 
Martin has worn a Marks Arm 29 years, W. H. Roberts, leg 32 years, 
Hugh Thompson 31 years, H. Van Ormondt 31 years, W. L. Agnew 30 
years, S. T. Criss 30 years, John B. Lawrence 30 years, Enos Lincoln 
30 years, Antonio Alarcon 29 years, Uriah Bursey 29 years, O. S. 
Chapman 29 years. John Nicol has used a Marks Arm for 29 years, 
H W. Posz, leg 29 years, J. W. P. 29 years, James W. Cullins 28 years, 
T. C. Fowler (arm) 28 years, R. D. Rodgers (leg) 28 years, Rev. G. W. 
Brownback 27 years, W. A. Clark, M. D., 27 years, James O. Kellum 27 
years, W. O. Miller (arm) 27 years, George W. Shipper (leg) 27 
years, J. M. Willard 27 years, Edward J. Gallagher 26 years, Rev. J. 
W. Knappenberger 26 years, Wolf Lorenzen 26 years, James A. Murta 
26 years, Peter Anderson writes: “lam still wearing the same leg I got 
from you in 1891, I have never left it off a day on account of sore 

St 7 P B. Boren 25 years, W. L. Caldwell 25 years, David M. H. Deupree 
25 years, George W. Hart 25 years, A. A. Jack 25 years, W. G. M. 25 
years and has put it to the hardest kind of use. J. R. Malcolm 25 
years, R. W. Powell 25 years, Edwin D. Smith 25 years, Joseph Smith 
25 years, M. B. Wells 25 years, C. E. Caney 24 years, Charles A. Christie 
24 years, C. C. Crane 24 years, Alf. De Root 24. years, George C. 
Hobbs 24 years, Hans Jacobson 24 years, Jos. S. Poirier 24 years, S. A. 
Benton 23 years, W. J. Kraft 23 years, A E. MacArthur 23 years, A. 
E Magoffin 23 years, William E. Nelson 23 years, Hugh Pike 23 years, 
James Tobin 23 years, John B. Young 23 years, A. J Zabnskie 23 
years, James Burton 22 years, Oscar Coins 22 years, J. A Jarratt 
22 years, S. W. Jones 22 years, F. M. Kelleher 22 years, W. L. Kuhn 22 
years A. L. Naylor 22 years, John Newstubb 22 years, John A. Nilsem 
22 years, Stephen Norman 22 years, C. D. Preston 22 years, W. T. 
Walker 22 years, Michael Aurich 21 years, Peter Champagne 21 years, 
James A. Crandall 21 years, Alfred Crewe 21 years Robert T. David¬ 
son M. D., 21 years, Albert Maiden 21 years, T. H. Morgan 21 years, J. 
H. Steele 21 years, Miss Mary A. Cummings 20 years, H. A. Jones 
20 years, Ralph E. Lock 20 years, Duncan McRae 20 years, C. H. 
Wolfe 20 years and thousands of others who have not written or men¬ 
tioned the years of patronage in their letters. 



280 A. A. Marks , Artificial Limbs, New York City. 


3rd Contention 

CONSTRUCTING AND FITTING ARTIFICIAL LIMBS BY MEAS¬ 
UREMENTS SUCCESSFUL, ECONOMICAL AND CONVEN¬ 
IENT: 

Seventy-four out of every hundred of testimonial writers obtained 
their artificial limbs by sending their measurements and having them 
constructed by them. The measurements were taken by their doctors in 
some cases, by mechanics familiar with measuring in others and very 
frequently by themselves with the assistance of some member of the 
family or a friend. This is very frequently done when women order 
for themselves. 

The process of taking measurements is very simple. It is fully illus¬ 
trated and described on measuring sheets we supply. The system has 
been so thoroughly worked out that there is hardly a possibility of an 
error. Disappointments are extremely rare. By this system it is pos¬ 
sible for a man living thousands of miles away to get a Marks Limb 
at the published price and be spared the inconvenience, loss of time and 
expense of traveling to New York. Far better for him to be measured 
at home and obtain the best, than to entrust his case to a locksmith, 
machinist, woodworker, shoemaker, or what not, located near him who 
has seen fit to establish himself as an artificial limb maker and puts 
out the argument that it is better to be fitted personally by a maker 
of little experience than be fitted by measurements by an expert. 

The making and fitting of artificial limbs is full of problems. Many 
years of experience and practice, many years of careful study are re¬ 
quired to equip a man to do the work properly. The anatomy of the 
stump, the circulation of the blood, the location and functions of glands 
are the same in all and should be understood by the fitter, otherwise 
grave consequences may result. It is far better to order a limb by mail 
and send measurements for its construction and have it scientifically 
fitted, than to entrust the work to a nearby mechanic who has not 
this knowledge and experience. 

Margaret M. Allison writes that she went to the city of Edinburgh 
and had a leg made and fitted to her personally, but the Marks Leg 
she got from measurements was much more comfortable. 

Sarah Fieldhouse writes that she had to take her old leg off several 
times during the day to relieve her stump, although the leg was fitted 
to person by a local maker, but when she got a Marks Leg fitted by 
measurements, she had comfort all the time and never took the leg off 
except on retiring. 

Judge D. C. Hawk of Kansas had worn a number of legs fitted to 
him personally, but the Marks made from measurements in 1913 gives 
him much better satisfaction. 

William S. Jones, living in Luzerne Co., Pa. (not very far from 
New York), has his limbs made by Marks, fitted by measurements, 
prefers to do so than to be subjected to the expense and loss of time 
of even a short trip. He says: “Personal fittings are entirely unneces¬ 
sary.” 

Jose Maria Jorge got a leg in Sao Paulo, Brazil, made and fitted 
to person; he could not wear it with comfort. Upon getting a Marks 
Leg fitted from measurements he wrote: “The leg is light and fits com¬ 
fortably.” 

John Madden writes regarding the leg he obtained from Marks that 
he could not have gotten a better fit if he had come to our factory. 

M. E. Martin of India went to England, got a leather socket fitted 
to person, had several, none of them fitted, they tortured him, but 



A. A. Marks, Artificial Limbs, New York City. 281 


the Marks Leg made and fitted by measurements was comfortable and 
far superior in every way. 

Francisco Silva of Central America tried a leg made by a local man¬ 
ufacturer ; it proved to be a failure, but the Marks Leg was a success. 

Further evidences regarding the efficiency of fitting from measure¬ 
ments are obtainable from Matias Ahumeda, Peter Anderson, W. C. 
Bliss, M. D. Silas W. Fickle, Bessie French, P. H. Garside, David 
Gluck, David Grant, George C. Hobbs, Robert Jackson, James Jeffrey, 
F. M. Kelleher, C. B. Kingsley, C. L. McClure A. F. McNaughton, 
E. George Moses, A. E. Oakes, George W. Oman, J. G. Shirk and 
others. 


4 th Contention 

MARKS ARTIFICIAL LEGS AND ARMS THE MOST SUITABLE 
FOR ALL OCCUPATIONS: 

The occupations of testimonial writers are given in nearly every case. 
These pursuits were followed while wearing Marks Artificial Legs and 
Arms with Rubber Feet and Hands. Men or women who do things, 
who are engaged in actual pursuits of life, present the strongest proo 
and are the beat guides. Nearly every occupation from the Deepsea 
Fisherman of Newfoundland to the Canal Diggers of Panama, from 
the woman housekeeper to the woman dressmaker; labors requiring 
firm, sound and dependable footing as well as those subjecting limbs 
to severe tasks are here represented. , , 

In lookino- over the list we note that Sam Berry marches with band 
and beats a°drum, amputation below knee. Louis Fournier, who wears 
a pair of Marks Artificial Legs, drives an automobile many hours every 
day and experiences no difficulties in operating the foot pedals. Mr. 
VY Hymison dances on a rubber foot so perfectly that no one suspects 
that one of his legs is artificial. Mr. John J. Kelly works on a swing¬ 
ing scaffold painting signs on lofty buildings. Mr. E. J. Oliver does 
the same, but he wears a Rubber Hand. Mr. C. F. Read with a Marks 
Foot pushes and pulls a hand truck loaded with a case weighing 1,000 
pounds. Mr. W. L. Smith plays pools with a Rubber Hand. 

It is indeed interesting to read what these wearers of artificial limbs 
do, showing beyond a doubt that the loss of one or even a pair of 
limbs, or the loss of an arm does not deprive a person of his ability to 
return to his preferred occupation, and earn his livelihood 

More women writing these testimonials are occupied with household 
work than any other occupation. Farming life among men seems to 
predominate, though wearing artificial legs and arms they do not per¬ 
mit the grass to grow under their feet. 

The pursuits of the writers of those letters may be classified as 

follows: • ^ _ , 

Accountant: J. V. Julian, G. D. Salway. 

Advertising Agent: W. L. Agnew. 

Aeronaut: F. E. Jacoby. . , . M 

Artificial Limb Representative: George Hy. Barstow, Antonio M. 

Geoff roy 

Artist: Jos. E. Keefe. _ TT 

Auditor: A. C. O’Neil, William E. C. Heyms. 

Auto Tire Manufacturer: J. Underwood. 

Automobile Agent: Henry W. Booth. -n * 

Automobile Driver: Dr. J. B. Aycngg (hand'), Edw. F. Beach 
(arm), Hy. W. Booth, M. C. Gallo, Ray W. Holden, Alfred H. 
Knapp, V R. May, Charles G. McCleary, C. L. McClure, James 
H. Smoot, H. F. Watson. 



282 A. A. Marks , Artificial Limbs, New York City. 


Baggageman: C. Bolduc, John L. Thomas. 

Baker: William Darragh, G. H. Kennedy, both legs. George A. 
McMahon, both legs amputated. E. M. Spedding, A. F. 
Sykes, both legs. 

Banker: Keith Edwards, Leslie Langill. 

Barber: D. O. Greene, Albert Maiden, Edw. McGonigal. 

Bayman: Alden Biggs. 

Bench Hand: James F. Callahan. 

Bicycle Dealer: R. A. Williams. 

Bird Dealer: P. S. Berges, John Dunn. 

Blacksmith: George Baldwin, John Dunn, T. F. Forster, Armi- 
tage Gothergill, J. A. Jarratt, J. G. McIntyre, A. F. 
McNaughton. 

Boatman: Alfred De Root. 

Booking Clerk: E. A. Oates. 

Bookkeeper: J. A. Arrighi, Carl Boysen, W. C. Corley, C. W. 
Couch, S. T. Criss, Hy. H. Daigle, Edward J. Gallagher, William 
E. C. Heym, H. A. Jones, Duncan McRae, E. E. Roberts, 

G. S. Salway. 

Bootblack: Harry V. T. Williams. 

Bottler: Charles Deifel. 

Bowling Alley Keeper: James Lahive. 

Broker: S. A. Benton. 

Builder: M. C. Gallo, G. D. Kerns, R. Thorpe. 

Cabinet Maker: Flavio Capricci, Ernest Robinson, C. H. 
W 7 olfe. 

Canning Factory: Harry Robbins. 

Canvasser: J. B. Bissonette, C. S. Michael. 

Carpenter: J. F. Baldridge, Charles Barrett, Bruno Bernier, H. T. 
Drake, Ramiro Gomez, D. M. Hillyard, I. J. Marks, M. C. 
Marshall, C. W. Nicholson, R. Thorpe, C. H. Wolfe. 

Carter: Eccles Crawford, John Gordine. 

Car Window Cleaner: B. J. Horton. 

Cashier: C. L. Lewis, R. W. Powell. 

Cement Laborer: Charles Tyrrell. 

Cemetery Work: James Baxter. 

Chauffeur: Louis Fournier, Clyde L. McClure, R. H. Malson, 
Albert Moreau, Mario Pillich y Colon, Richard T. Piper. 
Chemists: See druggists. 

Chiropodist: Dr. D. H. Ricker. 

Cigar Manufacturer: Jose Estevez, W 7 . L. Kuhn. 

Civil Engineer: Jonas E. Hesselman, Edw. C. Terry. 

Clams: Alden Biggs, A. W. Mills. 

Clergyman: Rev. G. W. Brownback, Rev. Oscar Gesner, Rev. E. 
W. Hawthorne, Rev. J. H. Kent, Rev. J. W. Knappenberger, 
Rev. Robert E. Pogue, Rev. J. W. Potter, Rev. Charles M. 
Reed, Rev. Charles B. Veillet. 

Clerk: William J. Bray, R. V. T. Buck, Arthur Caffrey, Charles 
Cerriter, W. C. Corley, James A. Crandall, Frank Dura, 

H. L. Farr, William Griffin, Robert D. Hamilton, W. E. 
Harrison, H. J. Holden, Roy Holt, James Jeffrey, S. M. 
Lehigh, George Lomas, Abelardo Lopez, Thomas H. Lygo, 
John Marshall, Felipe Montes de Oca, James W. Moore, 
James A. Murta, A. E. Oakes, L. Palmer, Luis Restrepe M., 
Walter Swanson, P. C. Thomas, Jos. J. Tuscamo, Miss Flora 
A. Thompson, W. T. Walker, L. C. Watson, A. W. Weaver, 
J. W 7 ebster. 

Coachman: Andrew C. Apgar. 

Coal and Feed Dealer: Isaac Post. 

Collector: Edw. Harris, Wilson Jones, T. C. Fowler, George G. 
Twitchell. 



A. A. Maries, Artificial Limbs, New York City. 283 


Commission Agent: W. M. Scandrett. 

Concrete Worker: C. A. Brown. 

Confectioner: Ewart W. Spedding, Albert F. Sykes (both legs). 
Contractor: M. C. Gallo, Thomas Killgour. 

Cook: Miss Minnie Osborne, H. A. Sutherland. 

Cotton Picker: D. W. Knowles. 

Cowboy: John W. Kent, E. P. Low. 

Customs Officer: A. J. J. Austin, M. D., A. Cantu, John Madden. 
Dancing Instructor: John Burkley. 

Delicatessen Store: George W. Steinmetz. 

Dentist: B. W. Makkink, F. H. Paul, R. F. Taggart. 

Die Maker: John H. Valentine. 

Dispatcher: W. H. Roberts. 

Draper: Harvey Gregson, Miss F. Jones, Miss N. Gostelow. 
Draughtsman: Edgar Broadley, David Grant, 0. S. Chap¬ 
man. 

Dressmaker: Miss R. E. B., Miss Adelaide Moody. 

Driver: Charles E. Chamberlain, H. J. Holden, J. J. Veal, John 
Vogel. 

Druggist: R. S. Cussans, A. E. Magoffin, Virgil R. May, A. W. 
Weaver. 

Editor: Antonio M. Geoffroy. 

Electrician: Jose Ortiz J. 

Engineer: R. C. Evans, William W. Grant, J. E. Hesselman, J. A 
McDonald, William McGettigan, John Nicol,. A. T. Peterson, 
Benjamin V. Smith, Edw. C. Terry, John Vial. 

Evangelist: Miss Louise B. Albach. 

Expressman: Frank Triacca (both legs amputated). 

Farmer: William Allison, Joel Avant, James Baxter, Hosea 
Beach, Adolph Bernauer, William G. Bierce, Harry Brooke, 
Ed. Boerner, A. B. Boren, J. F. Brewer, M. D., Thomas P. 
Brown, Andrew Bush, Euclid Cardinal, Russell Carmichael, 
J. D. Cluck, George Coleman, George Davis, J. C. Dawkins, A. 
S. Dennis, M. D. Dowell, Keith Edwards, Manuel Espinosa, 
John Fender, Silas W. Fickel, R. G. Floyd, M. D., Fred E. 
Gardiner, George A. Garland, James D. Gold, M. D., Raymond 
Grimmer, H. A. Haine, George W. Hart, Ray W. Holden, 
Jason House, Hans Jacobson, C. Jent (arm), James O. 
Kellum, August Kohrman, Carl Larson, J. P. Lee, M. M. 
Loomis, Wulf Lorenzen, Jack Lyles, W. G. M., H. E. Martin, 
R. H. McKinnon, I. J. Marks, C. B. Metcalf, Otto Meyer, W. 
0. Miller, Jacob Mumm, John Murray, Patrick Nolan, G. W. 
Oman, Christian Opp, Mr. Patrick, A. T. Peterson, A. S. 
Porter, M. D., J. A. Quigley, W. L. Ramsey, M. A. L. Richard¬ 
son, Harry Robbins, William Robinson, Lloyd Saylors, George 
Shafer, J. H. Sharrock, J. G. Shirk, Francisco Silva, John M. 
Smith, James H. Smoot, Jos. H. Steell, George G. Twitchell, 
Jos. M. Underwood, H. D. Unganst, Dolphus Villneff, George 
Wanamaker, J. B. Wessels, J. H. Willard, S. A. Wing, Sam 
Wood, H. Wright, C. A. Zellner. 

Fireman: Henry Erb, F. Foust, W. W. Grant, Martin Judge, C. E. 
Prather, R. D. Rogers, Henry W. Smith, Isaac Winfrey, Al- 
pheus Wright. 

Fish Dealer: Hy. F. Hicks (both legs). 

Fisherman: Charles Barrett, Olai Bertelsen, Henry Blake, Archy 
Bungy, Uriah Bursey, L. H. Crowley, Thomas Giles, Alfred 
King, C. Legge, John McKays, John E. Musson, Patrick Nolan, 
Alex. Noseworthy, John Sheahan. 

Fish Hatcher: Fred E. Gardiner. . . _ . , . 

Foreman: Maxime Cyr, P. J. McCarthy, T. C. Rams, A. Wright. 
Foundry Worker: F. R. Mobray, Wilfred Vandeji, 



284 A. A. Maries, Artificial Limbs, New York City. 


Fruit Grower: A. M. Caldwell, Frank T. Mason. < 

Gardener: Martin Baal, Harry J Breach, Peter Griffin, A. H. 

Knapp, M. J. Lowe. 

Governess: Miss Amy Campbell. 

Gravel Pit: H. Rosanowski. 

Grocer: A. J. Eckles, A. Loup, C. D. Preston, Edwin Walker. 
Harness Maker: Samuel Abrahams. 

Hay and Feed: John Scharff, George Shafer. 

Horse Dealer: W. A. Griffin. 

Horse Shoer: A. F. McNaughton, Enos Lincoln. 

Hosiery: Charles E. Welsh. 

Hostler: Selah L. Smith. 

Housework: Mrs. Walter Abel, Miss M. M. Allison, Mrs. A. Arm- 
itage, Miss Alice E. Bacon, Miss N. A. Bailey, Mrs. L. E. 
Bixler, Miss Ella Buerger, Mrs. F. Cardinal (both legs), 
Mrs. Grace Carsley, Miss Lena Dagenhart, Miss A. J. Dock- 
endorff, Mrs. H. B. Edens, Mrs. Robert Edgar, Mrs. Sarah 
Fieldhouse, Miss Bessie French, Mrs. Marie Frene, Mrs. 
Lilly A. Gibson, Mrs. Mary Grant, Mrs. Karoline Harmon, 
Mrs. H. Harvey, Drs. Hutchinson and Peebler, Mrs. Arthur 

B. Joseph, Mrs. Edna Lawrence, Mrs. Regina Mehl, Mrs. E. 
Murgatroyd, Miss Lillie Noethlicli, Mrs. Lula Oldham, Mrs. 

C. Quinn, Miss Fanny F. Reed, Mrs. F. Schur, Mrs. Hattie 
Sullenger, Mrs. E. E. Van Voorhis, Mrs. Lizzie Thornton, 
Miss Pollie Walker, Mrs. R. G. Westervelt, Mrs. John 
Whalen, Mrs. A. Wilkinson, Miss Lulu Wylie, Miss Isabella 
Youngs. 

Indian: C. B. Boyd, M. D., Z. T. Daniel, M. D., Andrew Pat, Ceca 
Yammi. 

Inspector: Edw. F. Beach. 

Insurance Agent: F. C. Beilin, S. W. Jones, F. W. Munford. 
Interpreter: Edw. W. Krautz. 

Journalist: Ricardo Charlin. 

Judge: D. C. Hawk. 

Laborer: W. L. Barnden, Francisco Castro, Alez. Coochman, Alex. 
Cooper, Toribio Cruz, James W. Cullins, Charles G. Dalrymple, 
Gerardo Dauma, A. Edquist, Rafael M. Espinoza, R. C. Evans, 
Jonas Greenhill, William Hanlon, Daniel W. Knowles, Alya 
M. Lindsey, A. B. Lynch, Leandro Martinez, J. C. Mathis, 
Pierre Mimmo, John Moore, William Mooreside, William Mor¬ 
gan, William E. Nelson, John A. Nilson, Patrick Nolan, 
George H. Parren, R. T. Sayville, M. D., Joseph Smith, J. 
Strangeway, Samuel Taylor, Charles E. Tyrell, Thomas Wil¬ 
liams, Michael Yuzsyzyn. 

Lawyer: B. S. Briggs, W. L. Caldwell, Juan Cardoso, Stephen 
Kelsey, G. Lorenzoni, W. S. Reddy, G. Perez Rivero, J. B. 
Saxon. 

Letter Carrier: H. F. Drake, C. L. Green, M. D., Thomas F. 
Lush. 

Lighthouse Keeper: George W. Purdy. 

Light Work: Vernon Knowles, William Morgan, William H. 

Potter, Charles E. Welsh. 

Logging: Albert Maiden. 

Lumber; William Hanlon, A. B. Lynch, Charles G. McCleary. 
Lumber Merchant: Charles G. McCleary. 

Machinist: Alex. Bagdricwics, M. B. Jarnagin, J. A. Jarratt, 
Frank Knowles, A. L. Naylor, Hugh Pike, E. P. Rice, M. D., 
George W. Shipper, Thomas W. Smith, A. H. Stephens. 
Manufacturer: John MacArthur, J. Underwood. 

Marketman: W. E. O’Brien. 

Mason: Eli Brown. 



A. A. Maries, Artificial Limbs, New York City. 285 


Mechanic: D. M. Green, C. J. Hamilton, M. D., It. Peel, John T. 

Rice, Mat. Rice, Harry Robbins. 

Medical Student: Jos. Lalung-Bonnaire. 

Merchant: Antonio Alarcon, G. Bennett, Atala Cuzmar, David M. 
H. Deupree, William Dobson, T. S. Edwards, Frank S. Gilles¬ 
pie, C. B. Kingsley, Charles G. McCleary, M. A. Parraga, 
Mark W. Penny, E. 0. Rentz, H. Van Ormondt, J. W. 
Vaughan. 

Military: Matias Ahumada, Col. Juan de Dios Alvarado, J. T. 
Chirino, General Gregorio Carrera, Jose Ignacio Lara V., 
General Ramiro S. Gonzalez, Matthew Norton. 

Milk Dealer: George A. Dawson. 

Milk Tester: C. C. Dalrymple. 

Millhand: John Birkmyer, Miss C. Dyson, William Hanlon, A. A. 

Jones, Matthew W. Sill, J. H. Willard. 

Miner: Edw. Beaudry, T. L. Bilson, J. J. Booth, John Brennan, 
A. C. Clark, E. R. Corfield, D. 0. Evans, John Fender, William 
S. Jones, J. M. Jordan, Sydney Joyce, Norman Lee, John 
McLean, James McMickle, S. M. Musselwhite, A. A. Quinn, 
Edw. Renwick, Walter Saunders, J. W. Taylor (both legs), 
Thomas Truscott, George Yates. 

Motorman: N. Lee, John Marshall, Edwin D. Smith. 

Musician: Charles Deifel, Thomas W. Keogh, Prof. Alex, von 
Skibinsky. 

Music Teacher: Miss Amy Pimblett. 

Newsboy: John Scharff. 

Notary: G. Lorenzoni. 

Nurse: Miss Hanna Fowler. 

Office Work: Jose Antonio Feria. 

Oil Well Pumper: Oscar Coins. 

Organist: C. W. Nicholson. 

Overseer: P. J. McCarthy. 

Oysterman: Alden Biggs, A. W. Mills. 

Packer: Frank J. Kunz. 

Painter: Harry J. Breach, James Halpin, John B. Lawrence, 
Charles McClellan, Thomas E. Neville, Earl J. Oliver, 
R. H. Perry, A. F. Peterson, George W. Purdy, Charles C. 


Shenton. 

Paper Hanger: James Halpin. 

Pearl Worker: Leon Krasker. 

Photographer: Charles A. Christie. 

Physician: Dr. J. B. Aycrigg, Lieut. J. A. Bailey, Dr. J Lalung- 
Bonnaire, C. C. Bose, M. D., W. A. Clark, M. D Robert T. 
Davidson, M. D., William B. Davis, M. D., Dr. H. E. Eldrtlge, 
J W Farrill, M. D. (arm), Dr. M. Lauritzen, L. B. McBray- 
er. Dr. Maximiliano Machada, J. B. McIntyre, M. D., Dr. C. 
E. Smith, Dr. E. G. Zey. 

Picture Framer: David Gluck. 

Pilot: J. H. Brown. 

Plasterer: James D. 

Plumber: George M. Burke. 

Policeman: Jos. T. Appleton, Paul R. Garside. 

Porter: Thomas H. Morgan, Julius M. Richards. 

Postmaster: Alfred Crewe, J. A. McDonald. 

Poultry Farm: I. J. Marks, Harry Robbins. 

Priest: Rev. J. F. Dobson, Rev. Charles B - Veillet. , , T 

Printer: Ramon Gamboa, Archer R. Johns, T. H. Palensky, J. E. 

Roper, G. W. Wright, John B. Young. 

Produce Dealer: Stanley J. Sanford. 

Proof Reader: C. A. Sargent. 

Pumper: N. Lee. 



286 A. A. Marks , Artificial Limbs , New York City. 


Quarryman: John McLean. 

Railroad: F. J. Bonner (switchman and signalman), William J. 
Bryan (conductor), Dan Cobb (brakeman), Daniel A. Daly 
(shop hand), Thos. Dabson (engine brakeman), Jack Dia¬ 
mond, Ira Edgar (conductor), Luis Estrada (conductor), F. 
Faust (fireman), Manuel R. Gonzalez, H. J. Holden (flagman 
and lineman), Charles J. Hymison (brakeman), A. A. Jack 
(agent), Jose Maria Jorge, Dr. Ladbury (flagman), Wm. Lezotte 
(gate tender), Daniel Mahoney (brakeman), L. D. Marshall, 
George Martin (switchman), Alex. McDonald (engineer), 
William McGettiner (engineer), H. R. Newell (engineer), 
Jose Ortiz (electrician), Louis Paris (flagman), A. H. Ple- 
mons (brakeman), William Roberts (chief dispatcher), Fred 
Rush (agent), A. B. S., F. B. Scroggins, Selah L. Smith 
(locomotive hostler), Thomas H. Smith, Walter L. Smith 
(switchman), Hamp Stephens, William Sullivan, John L. 
Thomas (baggageman), R. E. Thompson (official), Arthur 
Tipping, James Tobin. 

Ranchman: Cedric Kirkpatrick, E. P. Low, Ernest Zagelow. 

Real Estate: Edw. E. Bownes, William Campbell, Hector Mac- 
Fadyn. 

Restaurant: C. J. Doyle. 

Road Builder: A. Wright. 

Roll Turner: Thomas F. Prosser. 

Rolling Mill: A. W. Weaver. 

Roper: E. P. Low. 

Rural Delivery Carrier: H. T. Drake, Thomas F. Lush. 

Salesman: Gus E. Conrad, Dr. S. W. Dodge, Sidney E. Prest, Mr. 
Lizette. 

Saloon Keeper: Charles J. Hanley. 

Sash and Door Manufacturer: John MacArthur. 

Sawfiler: J. W. P. 

Sawmill: T. F. Forster, A. A. Jones, C. L. Linville, J. W. P. 

Sawyer: Elijah Hedgeman. 

Sealer: Hugh Thompson. 

Seamstress: Mrs. B. J. Shurtleff. 

Secretary: G. R. Champerdowne. 

Sexton: James Baxter. 

Sheep Herder: George Coleman, Price Nelson. 

Shoemaker: James R. Brunette, Alex. Coleman, Alfred Crewe, 
Silas W. Fickel, Wm. Fiddler, E. A. Gallup, Charles Gillespie, 
Robert Haak, Daniel W. Knowles, Frank Porter, Jos. Smith, 
Dr. A. F. Storey, Bernard Talbot, J. Veilleux, H. V. T. Wil¬ 
liams, H. R. Williams. 

Shop Hand: Miss Nellie Presdee, Wendel Riska. 

Signalman: Arthur James Earley. 

Sign Painter: John J. Kelly. 

Springmaker: Charles Salstrom. 

Stableman: Tony Sapio. 

Station Agent: George B. Garber, Fred Rush, J. J. Tim¬ 
mons. 

Steamboat Hand: Gerardo Dauma. 

Stenographer: Raymond C. Glass, D. W. Hoegg, Ralph E. Locke, 
E. L. Ramsey, William Storey, Jr. 

Stockman: E. R. Bingman, L. H. Harkey, John W. Kent. 

Stone Cutter: Charles F. Cole. 

Stone Mason: R. Wood Jenkins, J. W. Winn. 

Storekeeper: Ed. Chipman, W. T. Corey, W. L. Corgan, Robert 
Jackson, Richard Richards, George W. Steinmetz. 

Street Sweeper: John Matthews. 

Structural Work: Charles F. Cole. 



A. A. Maries, Artificial Limbs, New Yorlc City. 287 

Student: Annie N. Asselin, Carl Boysen, 0. A. Dickson, M D., 

J. de Menezes Freitas, C. W. Gallinger, J. L. Hedgepath, K. 
W. Holden. 

Sugar Factory: T. Ccuz. 

Surveyor: George R. Goddard. . 

Switchman: George Martin, Walter L. Smith, Arthur Tipping. 
Tailor: Peter Anderson, Walter C. Brooks, George H. Hurst, b. 

J. Keith, Mark Kelly, John McLay, George Thomas Pennell, 
Manuel Prado M. 

Tanner: L. C. Distler, M. D. 

Tap, Die and Punch Maker: John B. Lawrence. 

Teacher: C. X. Burgos, Miss Annie Eddy, C. W. Ford, James T. 
Gibson, David Howland, J. J. M. Kiernan, Miss E. M. Miller, J. 
Wesley Potter, Albert Pottle, B. F. Puckett, H. D. Unangst, 
Artemio Vasquez, A. W. Watton, Raymond R. Weaver, M. B. 
Wells 

Telegraph Operator: William L. Canfield, C. c - Crane Howard L. 
Hoover, F. M. Kelleher, B. F. Kendall, W. T. McDonough, M. 
E. Martin, Edw. Noonan, Jos. S. Poirier, George Russ, A. K. 
Sutton. 

Telephone Inspector: H. J. Holden. 

Tightrope Walker: F. E. Jacoby. . . . 

Time Keeper: W. C. Cooper, Alex. E. Jackson, Patrick 0 Bnen. 
Toolmaker: John H. Valentine. 

Traveling Salesman: Hudson Dickerman, S. A. Wing, A. w. 
Weaver. 

Treasurer: John C. Hamilton, Ala 0. Mosier. 

Truckman: Thomas Cahill, Charles F. Read 

Typewriter: R. C. Glass, Ralph E. Lock, Edw. Noonan, E. L. Ram¬ 
sey, George Russ, William Storey, Jr. 

Violinist: Prof. Alex, von Skibinsky. 

Violin Maker: Jos. W. Balmes. 

Warehouseman: Bernard Smith, Fred Swallow. 

Watchmaker: J. B. Bissonnette. . , , 

Watchman: John T. Halsell, M. D„ John Jennings, John New- 
stubb, Felippe Padrone, C. F. Roberts 
Weaver: Miss Blanche Baker, James Burton, G. H. Hurst. 
Weigher: Sidney Nicholls. 

Well Driller: James H. Smoot. 

Wireman: Perry Cole. 

Wire Stitcher: Fred H. Adams. 

Wood Finisher: H. Trageser. 

Yard Clerk: James A. Murta. 

Yardman: Fred Furness. 

These have mentioned in their testimonials what they have done in 

the sporting way: J ^ , _ , 

Miss Edith Barrett, leg amputated, plays tennis. 

Henry H. Daigle, leg amputated, goes hunting. 

Ramon Gamboa, both legs amputated, plays billiards. 

F. E. Jacoby, leg amputated, walks tightrope and skates. 

J. M. Jordan, foot amputated, goes hunting. 

James Lahive, leg amputated, bowls. 

John Marshall, arm amputated, runs motorcycle. 

James McDonald, both legs amputated, plays ball, goes boating, 
fishing, hunting, skating. Rides a bicycle. . 

Leslie Palmer, leg amputated, hunts, fishes, climbs mountains. 
Harry Robbins, foot amputated, rides a bicycle and hunts. 

Louis W. Selig, leg amputated, skates, rides a bicycle. 

Philip Sheridan, leg amputated, walked 40 miles. 

George W. Shipper, leg amputated, walked a foot race and won. 
Walter L. Smith, arm amputated, plays pool, dances. 



288 A. A. Maries , Artificial Limbs , New York City. 


Charles E. Welsh, leg amputated, plays golf, bowls, rides a 
bicycle and skates. 

Dr. G. W. Wright, leg amputated, rides a bicycle. 

Dr. E. G. Zey, leg amputated, hunts. 

5 th Contention 

MARKS ARTIFICIAL LIMBS ARE SUITABLE WHEN BOTH ARE 
AMPUTATED: 

The spring mattress rubber foot without ankle articulation affords 
many advantages to those who are deprived of both their limbs. The 
large surfaces of the soles of the feet are better bases to rest upon 
when standing and balancing than the articulating feet which are 
like pivots. In walking, the rocker motion of the rubber foot is more 
of a help than the flopping of the wooden foot. These conditions are 
of especial advantage to those who are amputated above the knees. 

P. S. Berges, born without legs; Archie Bungy, both legs; Carlos 
X. Burgos, both legs; Mrs. F. Cardinal, both legs; Juan Cardoso, both 
legs; Hudson Dickerman, both hands; John Dunn, both feet; Louis 
Fournier, both at ankles; Clarence W. Gallinger, both legs; Ramon 
Gamboa; David Gluck, right leg below knee, left foot at ankle; Harry 
Gregson, both legs; R. D. Hamilton, right leg at instep, left below 
knee; J. E. Hesselman, both below knees; H. F. Hicks, both below 
knees; Alex. Jackson, leg above knee and foot at ankle; Rev. G. H. 
Kennedy, both below knees; James McDonald, both legs; George A. 
McMahon, both above knees; Price Nelson, both below knees; T. E. 
Neville (painter, climbs ladders), right at knee, left below knee; W. 
S. Reddy, both legs; Jose Rios, Dr. Louis Ros, both below knees; 
Thomas H. Smith (weight 220 pounds), both below knees; A. E. 
Sykes, both below knees; J. William Taylor, right below knee, left in 
knee; Frank Triacca, both below knees; George G. Twitchell, both 
below knees; George Wanamaker, both below knees; L. C. Watson, 
right at ankle, left below knee; J. Webster, leg and arm; Charles 
Wilkin, both feet at insteps. 

6th Contention 

MARKS ARTIFICIAL LEGS ARE SUPERIOR FOR HIP JOINT AM¬ 
PUTATIONS : 

The Pelvic Socket and hip joint artificial leg for hip joint amputation 
is a proved success as attested by A. J. J. Austin, M. D., Miss Ethel 
Bairstow, Edgar Broadley, Grace Duff, D. C. Hawk, William E. C. 
Heym, Miss Minnie Osborne, A. H. Stevens, Dr. L. F. Woodward, 

7 th Contention 

MARKS RUBBER FEET AND ALUMINUM SOCKET LEGS THE 
BEST FOR ANKLE JOINT AND PARTIAL FEET AMPUTA¬ 
TIONS: 

So testifies Andrew C. Apgar, Martin Baal, Edw. E. Bownes, 
C. A. Brown, William L. Canfield, Charles A. Christie, Alex. Cooch- 
man, M. D. Dowell, John Dunn, James Earley, A. J. Eckles, Miss 
Annie Eddy, A. Edquist, Dr. R. G. Floyd, Louis Fournier, R. C. Glass, 
Robert D. Hamilton, Edw. Harris, D. M. Hilyard, H. J. Holden, James 
Jeffrey, J. M. Jordan, Sydney Joyce, W. J. Kraft, Corbette Legge, 
William Lezotte, C. L. Lineville, Daniel Mahoney, L. D. Marshall, H. 
E. Martin, Dr. L. B. McBrayer, Charles McClellan, Felipe Montes de 
Oca, G. R. Moses, John Newstubb, C. Nicholson, Albert Pottle, Thomas 
R. Rains, Charles Reed, Edward Renwick, Harry Robbins, R. D. 
Rogers, John Scharff, F. B. Scroggins, Charles C. Shenton, Harry W. 
Smith, Thomas W. Smith, James H. Smoot, L. L. Stewart, William 
Storey, Jr., William Sullivan, John L. Thomas, Arthur Tipping, John 
H. Valentine, Charles Wilkin, Harry V. T. Williams, S. A. Wing. 



A. A. Marks, Artificial Limbs, New York City. 289 


8th Contention 

RUBBER HANDS FOR PARTIAL HAND AMPUTATIONS ARE 
THE BEST: 

The desirability of using rubber hands when only parts of the hands 
have been removed is emphasized by many. 

Frederick H. Adams, James H. Adams, F. C. Ballin, C. A. 
Brown, Hudson Dickerman, Dr. C. A. Dresch, Mrs. Arthur B. Joseph, 
Mrs. G. Kraska, John Murray, Prof. A. Von Skibinsky, John Sirok, 
Edw. C. Terry. E. E. Van Voorhis writes that Mrs. Van Voorhis is lost 
when hand is off. When she wakes up at night and sees it off, she 
gets up and puts it on. J. W. Vaughan, H. F. Watson, M. B. Wells, C. 
A. Zellner. 

9th Contention 

WATERPROOF LIMBS MADE ONLY BY MARKS SHOULD BE 
SELECTED: 

Edw. Beaudry, W. A. Griffin, F. J. Holden, C. Legge, L. D. Martin, 
J. E. Musson, A. A. Quinn, Harry Robbins, who goes hunting through 
swamps, etc.; Edw. C. Terry, who works with an artificial hand in 
water and grease; Mrs. Fred V. T., who uses her leg while in bathing; 
Jos. M. Underwood (farmer), who works in all kinds of weather. 

10 th Contention 

RUBBER HANDS ARE THE MOST NATURAL IN APPEARANCE 
AS WELL AS USEFUL: 

So writes J. A. Bailey, M. C. Gallo, Charles J. Hanley, Mrs. Karoline 
Harmon, Wilson Jones, Mrs. A. B. Joseph, R. H. McKinnon, W. E. 
O’Brien, Walter L. Smith. 


11 th Contention 

MARKS ARTIFICIAL ARMS FOR AMPUTATIONS ABOVE THE 
ELBOW ARE USEFUL AS WELL AS ORNAMENTAL: 

It is not generally considered that an artificial arm is of very much 
practical value when the amputation is above the elbow joint. Al¬ 
though we do not claim a great amount of utility aside from orna¬ 
ment and the healthful influence they exert on the stump, it is a fact 
that many persons derive considerable service from them as testified 
to by Charles E. Chamberlain, Peter Champagne, Keith Edwards, Rev. 
E. W. Hawthorne, Connie Jent, Ala 0. Mosier, Jacob Mumm, Mrs. 
Lulu Oldham, E. J. Oliver, C. E. Prather, J. W. Potter, George W. 
Purdy, J. A. Quigley, George W. Sowers, P. C. Thomas. 

12th Contention 

MOTIONLESS ANKLES MOST HELPFUL AND MOST ECONOM¬ 
ICAL: 

It seems hardly necessary to make this statement, as it is self-evi¬ 
dent that the least amount of complication in any structure renders 
that structure stronger, lighter and more dependable. In regard to 
the advantages of artificial legs with rubber feet without ankle joints 
communicate with Leslie Langill, Mrs. C. Lorenzen, John MacArthur, 
who states that an artificial ankle motion is bound to be noticeable, 
more so than the rubber foot. Albert Maiden, Edward McGonigal, 
John T. Rice. 

13 th Contention 

THE SIMPLICITY OF MARKS MECHANISM MAKES LIMBS THE 
LEAST TROUBLESOME: 

Some put special stress upon the less troublesome side of the ques¬ 
tion. They are as follows: A. R. Jones, W. T. McDonough, William 
McGettigan, George S. Poirier, E. W. Spedding. 



290 A. A. Maries, Artificial Limbs , New York City. 


14 th Contention 

MARKS RUBBER FEET INSURE FURTHER AND FASTER 
WALKING: 

Some attach importance to their ability to walk further and faster 
on the rubber foot without ankle motion, than on any other kind. 
John Jones, Mrs. Regina Mehl. 

15th Contention 

MARKS LIMBS THE BEST FOR DANCING: 

Many value their artificial legs with spring mattress rubber feet on 
account of their ability to dance gracefully and enjoyably. Probably 
there is nothing that puts an artificial leg to greater strains and 
stresses than the quick, twisting movements on the foot required in 
dancing. So writes Antonio Alarcon, Miss Edith Barrett, John Burkley, 
G. Carrera, J. D. Conger, M. D., Miss Betty Doughty, F. J. Holden, 
W. Hymison, S. M. Musselwhite, L. Palmer, R. Peel, E. Sanchez, John 
Sheahan, Walter S. Smith. 

16th Contention 

RUBBER FEET AND HANDS NOT AFFECTED BY EXTREME 
CLIMATES: 

The question often comes up: “ Is the rubber foot or the rubber hand 
a safe one to use in hot or extremely cold climates?” Unreasonable 
as this question is, it nevertheless must be answered and we can do 
no better than refer those who wish to know to parties who are living 
or have lived for years in the coldest as well as the hottest parts of 
the world. Probably Manitoba is as cold as any inhabitable spot on 
the earth and as for extreme heat, India, Central America, West 
Indies and the northern part of South America can be regarded as the 
most intense for either dry or humid atmosphere. The simple fact 
that the rubber foot and rubber hand are neither conductors of heat 
nor absorbents of moisture makes the Marks Limbs immune to weather 
conditions, either hot, cold, wet or dry. Rubber is not injured by 
cold or dampness and only heat intense enough to boil water will 
affect its elastic permanency. 

Letters from the extremes of the world in climatic conditions have 
been written by the following: 

A. J. J. Austin, M. D., Mexico; Adolph Bernauer, Canada; J. M. 
Dulante, Peru, South America; John Fender, Alberta, Canada; W. 
Fiddler, St. Vincent, B. W. I.; Paul H. Garside, India; many in New¬ 
foundland, many in Panama, West Indies and Central America. R. 
Gomez, Central America; Gen. R S. Gonzalez, Venezuela, South 
America; W. Hymison, Panama; C. B. Kingsley, Saskatoon, Canada; 
J. A. Knowles, Santa Domingo; Jose Ignacio Lara V, Ecuador, South 
America; Dr. M. Machada, Brazil, South America; M. E. Martin, 
India; K. Manchurian, Turkey in Asia; G. Ochoa, Mexico; Manuel 
Prado, Costa Rica; S. E. Prest, Manitoba, Canada; Fred Rush, Mani¬ 
toba, Canada; Francisco Silva, Salvador Republic, Central America; 
William Storey of Wyoming, U. S. A., had to walk to keep from 
freezing; Artemio Vasquez, Porto Rico; J. B. Wessels, South Africa; 
Isaac Winfrey, who as fireman works in front of a furnace under in¬ 
tense heat. 

17 th Contention 

MARKS ARTIFICIAL LIMBS ARE MOST UP-TO-DATE AND ARE 
CONTINUALLY BEING IMPROVED: 

Although the Marks Artificial Limbs made half a century ago were 
excellent, they have been improved continually and are better now 
than ever before. The motive of 1853 to make limbs strong, light, 
efficient and as free from complication as possible is as strong today 
as it ever was as attested by: 



A. A. Maries, Artificial Limbs, New York City. 291 


W. L. Agnew, Martin Baal, Miss Alice E. Bacon, Alex. Bagdricwics, 
W. L. Canfield, Mrs. Grace Carsley, Alfred Crewe, William Griffin, 
A. A. Jones, Leon Krasker, Wolf Lorenzen, Felipe Montes de Oca, 
J. A. Murta, George W. Oman, A. T. Peterson (arm), Jos. S. Poirier, 
J. M. Richards, John Sheahan, R. E. Thompson, A. J. Zabriskie, 
E. Zagelow. 


18#7t Contention 

MARKS ARTIFICIAL LIMBS ARE MOST SUITABLE FOR HEAVY 
PERSONS: 

Letters of testimony show that the Marks Artificial Leg can be 
made strong enough without being excessively heavy for men of great 
weight occupied in active work as stated by: 

James W. Cullins, 242 pounds; Archer R. Johns, 200 pounds; Frank 
J. Kunz, 220 pounds; Thomas F. Lush, 165 pounds; Hester MacFadyn, 
175 pounds; Albert Maiden, 239 pounds; John McKays, 212 pounds; 
A. F. McNaughton, 235 pounds; Thomas F. Prosser, 175 pounds; 
Thomas H. Smith, 220 pounds (both legs) ; Mrs. John Whalen, 213 
pounds; S. A. Wing, 200 pounds. 

19 th Contention 

MARKS LIMBS ARE THE LIGHTEST: 

When required for delicate persons, the Marks Limb can be made 
the lightest and still be substantial. R. V. T. Buck, Gerardo Dauma, 
leg obtained elsewhere weighed 7% kilos, Marks only 3 kilos. Miss 
Polly Heald, Jose Ortiz, Thomas F. Prosser, L. Restrepo. 

20 th Contention 

MARKS ARTIFICIAL LIMBS ARE THE BEST FOR ELDERLY 
PERSONS: 

As stated in other publications, the advisability of applying 
artificial limbs to elderly persons cannot be emphasized too strongly. 
A few testimonials on this subject are worth considering. They 
provide ample proof in support of our contention that a person of 
advanced years who has lost a limb will enjoy better health, be more 
contented, happier and less dependent on others by having and wearing 
an artificial limb as affirmed by: 

Samuel Berry, aged 67, who writes he carries a small drum^ and 
marches in funerals; H. T. Drake, aged 70, occupation Rural Delivery 
Carrier, takes care of his own horse and drives daily 25 miles. Jacob 

G. Shirk, aged 76, drives four-horse disk-harrow. 

The testimonials of the following are interesting: Hosea Beach, 
aged 84; A. B. Boren, aged 70; Eli Brown, aged 76; Mrs. J. B. Clarke, 
aged 70; David M. H. Deupree, aged 72; W. Fickel, aged 69; Rev. 
Oscar Gesner, aged 75; D. M. Green, aged 76; William Griffin, aged 
71; George W. Hart, aged 71; Hoff, aged 70; Henry F. Hicks, aged 72; 

H. C. Hoff, aged 72; J. A. Jarratt, aged 74; C. S. Judy, M. D., aged 
70; John MacArthur, aged 67; A. E. Magoffin, aged 70; W. M. Scan- 
dret, aged 76; Jacob G. Shirk, aged 76; Mrs. Mary A. Smith, aged 77; 
Hugh Thompson, aged 73; John B. Young, aged 72; A. J. Zabriskie, 
aged 64. 

21 sit Contention 

MARKS ARTIFICIAL LIMBS ARE BY FAR THE BEST FOR CHIL¬ 
DREN: 

The Marks Artificial Legs and Arms have always been the best for 
young and growing children, either girls or boys. The strong, simple 
construction with few mechanical parts makes them preferable on 
account of the readiness with which they can be enlarged to accommo¬ 
date the growth and development of the wearers. 



292 A. A. Maries , Artificial Limbs, New Yorlc City. 


The Waterproof Feature is of additional advantage. Young, grow¬ 
ing children who are in good health, despite the fact that they are 
wearing artificial limbs, will run about, romp and play with other 
children in all kinds of weather, summer or winter, rain or snow, 
cloudy or sunshine. They are thoughtless and will get their artificial 
limbs wet and before they think of it the limbs are soaked. Artificial 
limbs of ordinary construction soon go to pieces under this treatment, 
but the Marks Waterproof Limbs will not be injured. It has been 
the experience of some families, who have procured artificial limbs of 
ordinary construction for their children, that the expense of keeping 
them in order was too much for their meager resources and in many 
cases they have required their children to abandon their limbs and 
get about on crutches. This is probably the most unwise and cruel 
thing a parent can do. Crutches support the body from under the 
arms and the use of them for a number of years is likely to distort 
the body, injure the lungs, weaken the chest and if only one crutch 
is used, the spine is likely to become curved. With a Marks Artificial 
Limb the objection on account of cost of maintenance is almost elim¬ 
inated, and the weight of the body is applied to the perineum, where 
it should be. 

The testimony of a number of the writers is to the effect that it is 
better to bring up a child on an artificial leg than on crutches, and 
that the Marks Waterproof Artificial Leg is the one to select on account 
of economy and facility with which changes can be made for growth. 

W. Belworthy says his daughter was 3% years old when she first 
put on an artificial leg. She is now 17 years old. Cosmost T. Cart¬ 
wright was six years old when he obtained his first leg. Read his 
letter written after he had reached his manhood. Felix M. Sidara, aged 
10, won a $10 prize in a bicycle race, although wearing an artificial 
leg. Brooke Steele says that artificial legs for growing children are 
better than crutches. ‘Frank Triacca, aged 13, both legs amputated. 
Floyd Turner writes a letter on the benefits of wearing an artificial 
arm, aged 12. 

Miss Fanny Adler, Joel Avant, E. R. Bingman, Albert Blakely, 
J. L. Bonnaire, J. J. Booth, William J. Bray, Rev. G. W. Brown- 
back, H. J. Cardinal, Grace Carsley, George Coleman, Arthur C. 
Croll, Miss Lean Dagenhart, H. F. Datesman, M. D., W. B. Davis, M. D., 
G. Duxbury, C. F. Frey, Mrs. F. N. Glass, Ray W. Holden, David 
Howland, Stephen Kelsey, William F. Kleckner, Mary Lavorata, S. J. 
Levenson, Wolf Lorenzen, L. D. Martin, Dr. William Mackechnie, 
John F. Mellor, C. E. McCoy, M. D., Otto Meyer, M. Parraga, 
Edw. F. Perreau, Miss Grace M. Phipps, Miss Julia Pittel, Augustin 
J. Prieto, W. L. Ramsey, John Scharff, L. M. Selig, Felix M. Sidari, 
A. Siracusa, J. M. Smith, Jos. H. Steell, M. Spinelli, Arthur Tom¬ 
linson, Floyd Turner, A. Vasquez, J. H. Willard, P. S. Willson, M. D., 
L. F. Woodward, M. D., Miss Lulu Kate Wylie. 

22 nd Contention 

RUBBER FEET CONDUCIVE TO HEALTH: 

There are a great many persons who do testify and many more who 
are willing to, that wearing an artificial leg with a rubber foot con¬ 
tributes to health. The jar which results from walking on wooden 
feet works upon the nervous system, with some it causes headaches, 
others get tired quickly, in fact there are all kinds of troubles and 
complications ascribed to the wooden foot, but with the spring mattress 
rubber foot, this jar is entirely removed. 

A clean socket has much to do with the health of the stump. Soft 
leather as well as padded sockets absorb perspiration, become foul 
and fetid, they not only emit a disagreeable odor, but are unhealthful 






A. A. Marks , Artificial Limbs, New York City. 293 


to the stump and are likely to infect it. The willow socket of the 
Marks type is sanitary and proof against these conditions. 

William Allison says the willow socket arm is cleaner and more 
healthful than the leather socket arm he had worn previously; per¬ 
spiration does not foul wood as it does leather. George W. Oman 
writes that he was troubled with boils when he wore an artificial leg 
with wooden foot. He became very much alarmed, did not know the 
cause, his doctor advised him to try the rubber foot, which he did. 
Immediately thereafter the boils disappeared and he has not had a 
recurrence. He attributes this to the absence of jar with the rubber 
foot. H. C. Hoff, aged 72, says that walking with the Marks Rubber 
Foot is a comfort and pleasure, and therefore he does more of it, 
which improves his health. M. J. Lowe writes that before he wore 
an artificial arm he suffered much from nerve troubles in his stump. By 
wearing an artificial arm and exercising his stump, conditions have 
improved and he is in better health. 

Mrs. A. Armitage, H. F. Datesman, M. D., Miss Annie Eddy, P. A. 
Garside, M. J. Jorge, Leon Krasker, E. E. Roberts. 

23rd Contention 

MARKS GUARANTEE ABSOLUTELY RELIABLE: 

Letters in too many cases to mention certify to the reliability of 
the Marks Guarantee. Every promise made by the house is faithfully 
fulfilled and in many cases the results derived far exceed all promises 
or even expectations. 

G. R. Champerdowne, A. C. Croll, William Griffin, James Jeffrey, 
Connie Jent, A. L. Naylor, Miss D. F. Webster, H. R. Williams. 



CHAPTER XXXVIII 

GEORGE HY. BARSTOW, BRITISH REPRESENTATIVE 


GEORGE HY. BARSTOW—Birkin House, Franklin Mount, Harrogate, 
Yorkshire, England, REPRESENTATIVE FOR A. A. MARKS IN 
GREAT BRITAIN. Below knee. Wears E-17. 

I had my leg amputated in 1884. I had worn a number of artificial 
limbs of English construction when I met a person wearing one of your 
make. I became interested in the way he walked, it seemed as though 
every step he took was more like nature than any I had ever seen, 
much more so than the leg I was wearing. He wore the spring mat¬ 
tress rubber foot and I wore the ankle jointed wooden foot leg. I im¬ 
mediately sent my measurements to you and had a leg made. It 
came promptly. I put it on and wore it from the start with comfort. 
I immediately became an enthusiastic walker and before I knew it 
and without any intention of soliciting orders for you, parties came 
to me and wanted me to order for them. I did so and in a short time 
found that my services were in demand. 

I wrote you and asked for the agency of Great Britain. You gave 
it to me. Since then I have ordered of you 380 artificial legs and 
arms for parties residing in England, Scotland, Ireland and Wales. 
The work is exceedingly pleasant and satisfactory to me, because I 
feel that I am doing much good to amputated persons in Great Britain. 

Perhaps it will be well for you to have the report from the Honorable 
Matron of the Brotherton Hall Hospital. Here it is: 

REPORT FROM DR. KATE MITCHELL WEST 
Honorable Matron 

BROTHERTON HALL HOSPITAL FOR WOUNDED 
BELGIAN SOLDIERS 

Brotherton, Yorkshire, October 4th, 1916. 

The Artificial Limbs manufactured and exported by the A. A. 
MARKS FIRM, of New York, U. S. A., and introduced into this 
country by their well-known and energetic representative, MR. G. HY. 
BARSTOW, of Harrogate, Yorks, have been supplied to wounded 
Belgian soldiers during their residence at Brotherton Hall Hospital 
and have brought the utmost satisfaction not only to the wearers 
thereof but to the Medical Staff. 

These Marks Limbs are infinitely superior to any that the under¬ 
signed has seen supplied by the English manufacturers—by reason of 
their perfect mechanism and splendid adaptability to varying require¬ 
ments and circumstances. They are designed and manufactured on 
sound scientific mechanical principles. 

A man with a Marks Leg (thigh amputation) is not prevented 
from carrying on his usual avocation, or in joining in athletic games, 
etc. As a matter of fact, it is difficult to discern the presence of an 
artificial limb when the wearer has become thoroughly accustomed to 
its use—which he does in a very short time. 

In two words these Marks Limbs are sui generis and should 
certainly be widely known and generously patronized, more particu¬ 
larly in these times of amputated limbs when every ounce of a man’s 
value must be preserved for his future use. 

KATE MITCHELL WEST, L. R. C. P. I., 

Bac. es. Ars.; M. I. S. A., Etc 
294 


A. A. Maries , Artificial Limbs , New York City. 295 


I have eighteen reasons why your make of artificial limb should be 
preferred to all others. They are as follows: 

They are fitted upon scientific principles by competent and skilled 
fitters, who are familiar with the anatomy of human stumps, and are 
consequently the most comfortable to wear. 

They obviate concussions to stumps. The sponge rubber foot affords 
a yielding medium upon which to walk and alight without jarring. 

The method of fitting and construction does not require the use 
of strangulating or choking slip-sockets to keep the stumps from 
abrading. 

They are noiseless. The absence of complicated ankle joints removes 
absolutely the tell-tale thud, thump and flop which are very objection¬ 
able features in other artificial legs. 

They will stand more exposure to heat, cold and moisture than any 
other. 

They are reliable to stand upon, and do not give a sensation of 
toppling over nor do they bend treacherously at the knees. 

They help in walking. In springing from the heel to the toe, prog¬ 
ress is aided and not impeded. 

They can be adapted to stumps of any length, from a partial foot 
amputation to a hip-joint excision. 

The methods of suspension are contrived to not only securely hold 
the legs, but “ give and take,” to avoid dragging at the shoulders. 

They are not only light but strong. 

They are durable. Their methods of construction combine strength 
without increase of weight. They are practically unbreakable. 

Their method of construction admits of changes being made in 
length to accommodate the growth of the wearer, when such growth 
takes place. This is absolutely necessary for children. 

The hands being made of rubber and cast in molds which are made 
from natural hands, have a finer resemblance to natural hands than 
those carved out of wood. 

The rubber hands do not wear out the gloves as quickly as wooden 
hands, the material being soft and yielding to contact. 

The fingers can be placed in many accommodating positions, and 
the fingers being made ductile, will respond to pressure communicated 
to them by the opposite hand. 

The hands can be removed without removing the arm, and useful 
implements can be placed in the forearm or in the palm of the hand. 

The rubber hand is soft to the touch, and doesn’t produce harsh or 
unpleasant sounds when coming in contact with other objects. 

The fingers do not break if the hand strikes a hard object. 

NOTE: Persons in Great Britain in need of artificial limbs are 
referred to Mr. Barstow. He will upon request send literature, make 
appointments, take measurements , apply limbs and instruct persons in 
using them. A. A. MARKS. 



CHAPTER XXXIX 

STUMP SOCKS. FOR ARTIFICIAL LIMB WEARERS 

COTTON, WOOL, AND SILKATEEN 

A stump bears the same relation to an artificial leg that a natural 
foot does to a shoe. Comfort and cleanliness demand that a sock 
should be worn on the stump, the same as on the foot. 

A sock in either case provides a medium for collecting and absorb¬ 
ing the particles of waste and moisture that are thrown off from 
the skin, and by removing the socks, airing, and frequently wash¬ 
ing them, the stump will be kept in a more healthy condition, and 
the socket of the leg will be better cared for. 

There are persons who do not use socks, but wear their artificial 
limbs directly to their stumps, and permit the sockets to collect and 
absorb the excretions of the skin, and when the sockets become 
foul with the collection of effete matter, they are scraped out and 



revarnished. This method cannot be condemned too strongly. 
The stump, as well as the artificial leg, suffers from such treat¬ 
ment. 

Every wearer of an artificial limb should be provided with an 
ample supply of socks, so that frequent changes can be made. The 
same regard should be given to the stump as is given to the natural 
foot. If a stump perspires excessively, changes should be made 
more frequently. 

We manufacture our own socks, and keep a large stock on hand 
and are able to fill orders promptly. 

Our socks are ma> ■» of cotton, wool, and silkateen. 

Cotton socks are knit of choice staple, they are durable and pleas¬ 
ant to wear; they are preferred by those who cannot endure wool. 

Woolen socks are knit from yarn especially prepared for the pur¬ 
pose; the yarn is the best and softest that can be procured, with 
only enough twist to make it wear well. It is absolutely free from 
cotton or any foreign fiber. 

Silkateen socks are made from exceptionally fine thread, they are 
knit on a.machine constructed for the purpose; meshes are small, 
sixteen stitches tp tjie inch, much finer titan spcks made from cotton 

290 













































A. A. Maries, Artificial Limbs, New Yorle City. 297 


or wool. These socks are especially suitable for tender and delicate 
stumps. Silkateen is a comparatively new thread; it is strong and 
will stand the effects of wear a great length of time. It has a 
luster resembling silk; it is very smooth and soft to the touch. 

Cotton and woolen socks are made in two colors, white or brown 
silkateen socks are of a natural grayish tint. 

Our stock consists of eleven different sizes, ranging from ten to 
thirty-six inches in length, and in width to fit any ordinary limb. 

In ordering socks the following measurements should be given:* 

Length of Sock. Circumference at top of Stump, 4 inches 
from top, 8 inches from top, 12 inches from top, 16 inches from top, 
20 inches from top, 24 inches from top, 28 inches from top. 

Some persons use a long sock to cover the stump to the body, 
and a shorter one to cover the stump to the joint (knee or elbow). 

When a short one is needed, give only the length and circumfer¬ 
ences of that part of the limb that is to be covered. 

The following schedule will enable anyone to determine the sizes 
and the prices of the socks required. 

PRICE LIST OF STUMP SOCKS 



Sizes in : 

inches. 

Cotton. 

Silver 

Woolen or 
Silkateen. 

Size 

Length of 

Circumference 
at largest 

Price 

Per 

Price 

Per 

Price 

Per 

No. 

sock. 

part of stump. 

each. 

dozen. 

each. 

dozen. 

each. 

dozen. 

0. 

1 to 10 

Under 15 

$0.25 

$2.50 

$0.40 

$4.00 

$0.60 

$6.00 

1. 

10 to 15 

“ 15 

35 

3.50 

.50 

5.00 

.70 

7.00 

2. 

10 to 15 

Over 15 

.45 

4.50 

.60 

6.00 

.80 

8.00 

3. 

15 to 20 

Under 15 

.45 

4.50 

.60 

6.00 

.80 

8.00 

4. 

15 to 20 

Over 15 

.55 

5.50 

.70 

7.00 

.90 

9.00 

5. 

20 to 25 

Under 15 

.55 

5.50 

70 

7.00 

.90 

9.00 

6. 

20 to 25 

Over 15 

.65 

6.50 

.80 

8.00 

1.00 

10.00 

7. 

25 to 30 

Under 15 

.65 

6.50 

.80 

8.00 

1.00 

10.00 

8. 

25 to 30 

Over 15 

.75 

7.50 

.90 

9.00 

1.10 

11.00 

9. 

30 to 35 

Under 15 

.75 

7.50 

.90 

9.00 

1.10 

11.00 

10. 

30 to 35 

Over 15 

.85 

8.50 

1.00 

10.00 

1.20 

12.00 


Sent postpaid if remittance accompanies the order. 

One-quarter or one-half dozen of the same kind and size sold at dozen rates. 
In some cases of amputation below the knee, a short sock in addition to a full 
length one to come only to the knee joint is desired. For such cases No. 0, 1 or 3 
will be suitable. In determining the number of size, 5 inches should be added to 
the length of stump to allow for turning over the top of leg and tne shortening 
caused by the stretch in drawing on the stump. 


SUPPLIES FOR ARTIFICIAL LIMB WEARERS 

Elastic Webbings, 2 inches wide, 80c. per yard; iy 2 inch wide, 70c. per 
yard; 1 inch wide, 60c. per yard. 

Non-Elastic Webbings, 2 inches wide, 40c. per yard; iy 2 inch wide, 
35c. per yard; 1 inch wide, 30c. per yard. 

Clamp Buckles with Snap, 1 y 2 and 2 inches, 25c. each; Snaps, 1 y 2 and 
2 inches, 20c. each. 





















298 A. A. Marks, Artificial Limbs, New York City. 


Pronged Buckles, nickel-plated, for buckling in webbing, 2 inches, 1 % 
and 1 inch, 5c. each. 

Roller Buckles, nickel-plated, for buckling in leather, %, %, % and 
1 inch, 10c. each. 

Knee-Side Joints, E-23, for below-knee amputations, $12.00 per pair. 

Screws, Bolts and Bushings, for Side Joints; Screws A, 30e. per pair; 
Bolts B, 60c. per pair; Bushings C, 60c. per pair. 

Check-Strap Lacings, for back of leg, amputation below knee, 40c. 

Lacings of fine buckskin, 60 inches long, 40c. each; $4.00 per dozen. 

Eyelets, 5-16 or % inch holes, 10c. per dozen. Rings, Style A, B, C, or 
D, 20c. per doz. 

Lacing Hooks, brass, nickel-plated, Style A or B, 50c. per dozen. 

Pocket Oil Cans, 25c. each. Screw Drivers, 20c. each. 

Knee Bolt Joint F 6, Bolt a, $3.00 each. Set Screw 6, 10c. each. 
Check Cord Screw c, 20c. each. Check Cord d, $3.00 each. Piston g, 
15c. each. Springs h, 25c. each. Cylinder i, 50c. each. Leather 
Cover, 10c. each. 

Knee T-Joint H 17; T-Joint a, $5.00 each; Screws 5, or i, 20c. each; 
Caps c, 25c. each; Piston d, 15c. each; Springs e, 25c. each; 
Cylinder /, 50c. each; Leather Cover g, 10c. each. 

Suspenders, No. 835, $2.00; E 60, $2.50; E 61, $4.00; E 62, $5.00; H 28, 
with rollers and straps, $5.00; H 34, $4.00; H 35, $6.00; H 37, 
with rollers and cords, $7.00. Straps attached to Corset, 75c. each 
strap. Arm Suspenders, $3.00 each. 

Suspender Rollers, A, B and C, 40c. each. Roller Straps, 36 inches 
long, 50c. each. 

Peg-Leg Ferrule, complete, E 57, $2.50. Ferrule, E 58, $1.50 each. 
Rubber Tips, E 59, $1.00 each. 

Arm Implements: Knife, $1.00 each; Fork, $1.00 each; Hook, $1.50 
each. 

Gloves, made of strong kid, $2.00 per pair; Single Glove, right or left, 
$1.50 each. 

Felt for pads and linings, per square inch, 1-16 inch in thickness, ^4c.; 
y 8 inch, y 2 c.; 3-16 inch, %c.; % inch, lc. 

Socks and Supplies will be sent postpaid if remittance accompanies 

the order. 


HOW TO REMIT 


You can send postage stamps, money order, registered letter, express 
or draft on New York. No goods will be sent C. O. D. unless one-half 
the price is enclosed with the order. 

Address: A. A. MARKS, 702 Broadway. 

New York, U. S. A. 





CHAPTER XL 

HOW TO REACH ODR ESTABLISHMENT 

We have endeavored to impress the fact that personal fitting's 
for simple amputations are as a rule unnecessary, and that we do 
not advise anyone to go to the expense and annoyance incident to 
coming to us without first making an attempt to obtain a suitable 
artificial limb by measurements. In order to place the matter 
on a basis of safety to the wearer, we obligate ourselves to make 
all alterations and refittings (should they be necessary) without 
charge. 

It is also emphatically stated that amputations leaving the stump 
with abnormal conditions, incapable of being explained either by 
drawings, descriptions or casts, are exceptions, fittings in such 
cases should be personal. Those who decide to come to us for per¬ 
sonal attention will be welcomed and promptly attended to on 
their arrival. 

WHERE WE ARE LOCATED.—We are located at 702 Broadway, 
N. E. corner of Fourth Street, a distance of less than two miles 
from every railroad and steamboat terminal. $1.00 or $1.50 is the 
most that can legally be charged for carriage or taxicab to convey 
a person to our door. Any person can, however, take a car at 
the point at which they arrive and be conveyed to Broadway and 
there transferred to a car that will stop at our door. Five cents 
will pay the fare. The system of transfers in New York is very 
convenient and accommodating. 

WE MEET PATRONS.—We will meet any person on arrival, if 
we are made acquainted with particulars a day or two in advance, 
provided the arrival occurs during the day. If it occurs after 
business hours, it will be well for the person to go immediately to 
some reputable hotel near by and remain there overnight. The 
Broadway Central Hotel, 671 Broadway, is within 300 feet of our 
establishment. 

BUSINESS HOURS.—Our establishment is open for business 
from eight o’clock in the morning to five o’clock in the afternoon, 
except Saturdays when we close at one o’clock. We are not open 
Sundays or holidays. 

BOARDING AND LODGING.—Accommodations can be obtained 
at reasonable rates in New York City. Furnished rooms in private 
houses can be had for from $2.00 to $5.00 per week, table board 
can be had from $3.00 to $5.00 per week. Rooms in hotels vary 
from fifty cents to $2.00 per night, with board from $2.00 to $5.00 
per day. A person coming to New York expecting to remain a week 
or more, and wishing to keep expenses down, can engage a fur¬ 
nished room and eat in restaurants, living expenses while here can 
thus be kept within narrow limits. The Mills House, located at 
164 Bleecker Street, is within one-half a mile of us. This is one 
of a chain of hotels conducted for the accommodation of respectable 
men of small means. A room can be had for twenty cents per 
night and meals at fifteen cents each. 

WHERE TO HAVE YOUR MAIL ADDRESSED.—Upon leaving 
home, instructions should be given to address letters and. tele¬ 
grams to the care of A. A. Marks, 702 Broadway, New York City. 

Patrons have the liberty of our premises while in New York, and 

299 


300 A. A. Maries, Artificial Limbs , New York City. 


if they are shopping, they can have their goods delivered at our 
store. They can make engagements to meet parties here and have 
the exclusive use of private rooms for private interviews. 

CALLS MADE TO RESIDENCES.—Persons will be attended to 
at their residences, no matter where they may reside, if expenses 
and extra time are paid for. 

WOMEN IN ATTENDANCE.—Women who prefer to be waited 
upon by one of their own sex, will find women in our ofiice for 
their accommodation. 

BRANCHES.—We have no manufacturing branches. Our factory 
is located in New York City and in no other place. Our skill and 
judgment cannot be relegated to one in charge of a manufacturing 
branch. If we were to establish branches we would have to place 
them under the management of others and would, more or less, 
jeopardize the welfare of our patrons. As substitutes for branches, 
our system of fitting from measurements has been devised and 
found adequate. 

If the reader desires to order a limb and does not care to take 
measurements himself, he can call upon his physician or druggist, 
or upon one whom we will designate, and have measurements taken. 

CAUTION 


Artificial limbs with rubber hands and feet are the inventions of 
A. A. Marks and the members of the firm bearing that name. 

The patents that are owned by the firm have the following dates: 


March 7, 1854. 

December 1, 1863. 

March 7, 1865. 

November 16, 1880 (First). 
November 16, 1880 (Second). 
March 30, 1886. 


July 12, 1887. 
March 8, 1892. 
January 3, 1893. 
September 17, 1895. 
July 9, 1912. 

June 20, 1922. 


These patents not only cover the original inventions, but the more 
important improvements that have been made upon them. 

The limbs have proved a blessing to the maimed. They stand peer¬ 
less before the world. Over 53,000 have been put in use, and the verdict 
is overwhelmingly in their favor. 

The large and increasing demand for Marks inventions has excited 
the envy of our competitors. Discarded inventions and expired patents 
of a quarter of a century ago have been more or less mutilated and 
offered as rubber feet, rubber ankles, rubber toes, pneumatic pads, 
etc., etc. 

We advise all persons who are in need of artificial limbs to deal di¬ 
rectly with us, and obtain the genuine and not submit to doubtful 
experiments. 

Order should state that none but Marks artificial leg or arm will 
be accepted. The genuine bear the name of the firm and the dates 
of patents. 


Established 1853. 


A. A. MARKS, 

702 Broadway, New York, U, S. A. 




A. A. Marks, Artificial Limbs, New York City. 301 


PRICE LIST 

PRICES: ARTIFICIAL FEET AND LEGS 


tions, described on pages 27 to 36, 


described on pages 37 to 44. 


ta- 

... Cut C 2 

each 

$ 40.00 

Cut C 5 

u 

60.00 

Cut C 18 

a 

90.00 

Cut C 25 

a 

90.00 

Cut C 27 

a 

90.00 

Cut C 28 

a 

135.00 

►ns, 

.. . Cut D 7 

a 

90.00 

Cut D 12 

a 

90.00 

Cut D 14 

u 

90.00 

Cut D 16 

a 

90.00 

Cut D 21 

u 

135.00 

Cut D 23 

tt 

135.00 


described on pages 45 to 


. . . Cut E 2 

a 

135.00 

Cut E 7 

a 

135.00 

Cut E 17 

a 

135.00 

Cut E 28 

a 

90.00 

Cut E 40 

a 

135.00 

Cut E 44 

« 

150.00 

Cut E 46 

u 

135.00 

Cut E 50 

a 

135.00 

Cut E 51 

cc 

135.00 


described on pages 67 to 71 


Ferrules and Rubber Tips for Peg Legs, 

described on pages 71 and 72. Cut E 57 

Cut E 58 
Cut E 59 

Suspenders, described on pages 71 and 72.. Cut E 60 

Cut E 61 
Cut E 62 

Straps attached to corsets. Cut E 63 

Or, $0.75 for each strap, corsets to be 
furnished by wearer. 

Artificial Legs for Knee-Bearing Stumps, 

described on pages 73 to 77. Cut F 5 

Cut F 9 

Peg Legs for Knee-Bearing Stumps, de- 

scribed on pages 77 and 78. Cut F 11 

Cut F 13 

Artificial Legs for Disarticulated Knee 
Stumps, described on pages 79 to 83... 


. . . Cut E 

54 

U 

25.00 

Cut E 

55 

(C 

60.00 

Cut E 

56 

a 

100.00 


Cut G 7 
Cut G 8 


Artificial Legs for Thigh or Femoral 
Stumps, described on pages 84 to 93... 


complete 

each 

set 


Peg Legs for Thigh Stumps. 


Cut H 5 
Cut H 15 
Cut H 25 
Cut H 26 
Cut H 27 


2.50 

1.50 
1.00 
4.00 
4.00 
6.00 
1.50 


each 135.00 

“ 135.00 

“ 25.00 

“ 100.00 

“ 75.00 

" 135.00 

“ 135.00 

“ 135.00 

“ 135.00 

“ 100.00 

“ 75.00 

“ 100.00 












302 A. A. Marks, Artificial Limbs, New York City, 



Suspenders, described on pages 94 to 97.... 


Straps attached to Vests. 

Or, $0.75 for each strap, Vest to be 
' furnished by wearer. 

Straps attached to Corsets. 

Or, $0.75 for each strap, Corset to be 
furnished by wearer. 

Artificial Legs for Hip-Joint Amputations, 
described on pages 98 to 100. 

Artificial Feet and Legs for Deformities, etc. 


Cut 

H 

28 

set 

$ 5.00 

Cut 

H 

34 

a 

5.00 

Cut 

H 

35 

a 

8.00 

Cut 

II 

36 

a 

3.00 

Cut 

H 

37 

it 

7.00 

Cut 

H 

38 

tt 

3.00 

Cut 

I 

5 

each 

150.00 

Cut 

I 

7 

ii 

200.00 

Cut 

K 

3 

it 

40.00 

Cut 

K 

7 

ii 

90.00 

Cut 

K 

11 

it 

90.00 

Cut 

K 

16 

ii 

90.00 

Cut 

K 

17 

ii 

135.00 

Cut 

K 

20 

it 

90.00 

Cut 

K 

22 

a 

135.00 

Cut 

K 

25 

a 

90.00 

Cut 

K 

27 

a 

90.00 

Cut 

K 

29 

a 

135.00 

Cut 

K 

31 

ii 

135.00 

Cut 

K 

33 

ii 

135.00 

Cut 

K 

35 

it 

135.00 

Cut 

K 

36 

a 

150.00 

Cut 

K 

38 

a 

135.00 

Cut 

K 

41 

a 

135.00 

Cut 

K 

42 

a 

135.00 

Cut 

K 

46 

both 

210.00 

Cut 

K 

51 

each 

135.00 

Cut 

K 

54 

a 

150.00 

Cut 

K 

57 

both 

270.00 

Cut 

K 

59 

a 

270.00 

Cut 

K 

61 

each 

90.00 

Cut 

K 

63 

ii 

150.00 

Cut 

K 

66 

ii 

150.00 

Cut 

K 

69 

ii 

90.00 

Cut 

K 

71 

it 

100.00 

Cut 

K 

72 

a 

100.00 


PRICES: ARTIFICIAL HANDS AND ARMS 


Artificial Fingers for Partial Hand Ampu¬ 
tations, described on pages 216 to 219.. 


Artificial Hands for Partial Hand Amputa¬ 
tions, described on pages 219 to 220... 

Artificial Arms for Wrist-Joint Amputa¬ 
tions, described on pages 221 to 223... 


Cut 

P 

9 

each 

$ 40.00 

Cut 

P 

10 

it 

40.00 

Cut 

P 

23 

it 

60.00 

Cut 

P 

24 

it 

60.00 

Cut 

P 

25 

ii 

60.00 

Cut 

P 

26 

a 

60.00 

Cut 

P 

38 

it 

60.00 

Cut 

Q 

8 

a 

50.00 

Cut 

Q 

9 

a 

50.00 

Cut 

Q 

10 

a 

50.00 

Cut 

Q 

11 

a 

50.00 

Cut 

Q 

16 

it 

60.00 






A. A. Marks, Artificial Limbs, New York City. 303 


Artificial Arms for Forearm Amputations, 
described on pages 224 to 229. 


Peg Arms for Forearm Amputations. 

Suspenders for Forearm Amputations. 

Artificial Arms for Elbow-Joint Amputa¬ 
tions, described on pages 230 to 232.. . 

Peg Arms for Elbow-Joint Amputations.. . 

Artificial Arms for Above-Elbow Amputa¬ 
tions, described on pages 233 to 234.. 

Suspenders for Above-Elbow Amputations. . 

Peg Arms for Above-Elbow Amputations .. 

Artificial Arms for Shoulder-Joint Amputa¬ 
tions, described on pages 235 to 237... 


Appliances for Deformities, Excisions, 
Weakened Joints, etc., described on 
pages 242 to 245. 


Arm Implements 


Cut R 

7 

each 

$ 60.00 

Cut R 

8 

if 

50.00 

Cut R 

13 

tt 

60.00 

Cut R 

14 

a 

40.00 

Cut R 

15 

a 

50.00 

Cut R 

16 

tt 

3.00 

Cut S 

2 

a 

100.00 

Cut S 

3 

a 

100.00 

Cut S 

4 

tt 

90.00 

Cut S 

5 

ft 

60.00 

Cut T 

3 

ft 

100.00 

Cut T 

4 

tt 

100.00 

Cut T 

5 

tt 

3.00 

Cut T 

6 

ft 

60.00 

Cut U 

5 

it 

125.00 

Cut U 

6 

ft 

125.00 

Cut U 

7 

ft 

125.00 

Cut W 

1 

tt 

50.00 

Cut W 

2 

a 

50.00 

Cut W 

4 

a 

35.00 

Cut W 22 

it 

125.00 

Cut X 

1 

tt 

1.00 

Cut X 

2 

tt 

1.00 

Cut X 

3 

tt 

1.50 

Cut X 

4 

a 

1.50 

Cut X 

5 

tt 

1.50 

Cut X 

6 

tt 

1.50 

Cut X 

7 

a 

8.00 

Cut X 

8 

tt 

3.00 

Cut X 

9 

a 

3.50 

Cut X 

10 

tt 

5.00 













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